Therapies

We offer the full spectrum of modern reproductive medicine at the highest quality level.

In extensive conversations we will dicuss all of our findings with you and make recommendations for your personalised therapy.

Hormone Therapy

Hormone Therapy

Couples in which the woman's hormone levels are the only cause of infertility can often get pregnant after a simple hormone therapy.

Some of the hormone levels which may need adjusting can be effectively and simply treated with a pill.

If the hormonal changes cause a disruption in the cycle, then the maturation of the egg cells can be optimised with the help of a stimulation therapy.

A stimulation treatment starts at the beginning of a cycle. By means of injections, FSH (follicle stimululating hormone) and also LH (luteinizing hormone), which are usually both produced naturally by the body, can be administered.

With our detailed and sensitive guidance, you will undoubtedly be able to administer these injections yourself on a daily basis.

We will monitor the growth of the follicles 1 to 2 times per week. Our meticulous work ensures you that the risk of a multiple pregnancy is carefully avoided.

We are happy to discuss the therapy procedure and progress with you at any time in a transparent and understandable manner.

Ultimately, the timing is the deciding factor just before ovulation. Therefore ovulation is activated by an additional injection (HCG), in order to optimise the chances of a successful fertilisation.

It may also be necessary to provide additional hormonal support in the second half of the cycle. This helps ensure that the fertilised egg cell is able to nidate in the uterine lining. After ovulation the daily injections will no longer be necessary.

As soon as the pregnancy is achieved you can visit your gynaecologist for normal prenatal care.

Insemination with the Partner´s Sperm - Homologous Insemination

Insemination with the Partner's Sperm – Homologous Insemination

Artificial inseminations are an uncomplicated way to get pregnant if the quality of the sperm is only mildly deficient, or if the sperm and the cervical mucus are not compatible.

Shortly before ovulation, a processed and highly concentrated sample of the partner's sperm is placed directly in the uterine cavity with the help of a soft plastic catheter. This procedure is not any different for the woman than a routine cancer screening test.

In certain cases it may be wise to combine hormone therapy with artificial insemination, in order to achieve a higher pregnancy rate.

Insemination with Donor Sperm - Heterologous Insemination

Insemination with Donor Sperm – Heterologous Insemination

In cases of sperm donor treatments, we complete the insemination (see above) using a donor's semen sample.

This method of therapy may be considered if the partner is unable to provide any sperm, if a genetic illness prohibits using the sperm or if multiple attempts at artificial insemination have failed.

If the problems relate to the woman's reduced fertility (e.g. blocked fallopian tubes) as well, artificial insemination with a donor's sperm is also possible.

It is crucial for the couple to be in full agreeement. The desire and the will to have and raise a child who is genetically related to only one of the partners are essential.

Before treatment begins we will also discuss alternative concepts of life (child adoption or fostering) together with you.

We are successfully cooperating with two donor sperm banks, one situated in Hamburg [IRC – Institut für Reproduktionsmedizin und Cryokonservierung GmbH], and one in Erlangen.

IVF - In Vitro Fertilisation

IVF – In Vitro Fertilisation

IVF (in vitro fertilisation) refers to the classical procedure of fertilisation in a test tube. In certain cases of fertility dysfunction the steps to fertilisation are performed outside of the body in the laboratory, rather than taking place in the fallopian tubes or in utero. In the following we will explain each step of the treatment.

Female hormone therapy is aimed at achieving the maturation of several egg cells within a single treatment cycle. The hormone therapy is administered via daily injections, which our patients give themselves after we provide careful instructions as to how this is done. The therapy's success is monitored by means of ultrasonic scanning. Depending on the number and size of the antral follices the hormone dose is adjusted to your personal needs. At this point a decision is also made as to when the egg cells should be extracted from the ovaries (follicle puncture, see below). During the first 10 to 14 days of the treatment, it will be necessary to perfom 2 to 3 ultrasonic scans.

The ultrasound-guided extraction of eggs (called follicle puncture) is performed vaginally, under a short anaesthesia. We require a fresh sperm sample from your partner on this occasion. After a short recovery period, the couple can leave the practise.

It is important that the couple has already decided how many embryos should be saved at this time. Of course we offer you a professional consultation in this matter. Our goal is to ensure a high pregnancy rate, while at the same time avoiding a multiple pregnancy.

To enable a successful embryo transfer 2 to 3 days later, the following steps are required in the laboratory:

The following day, approximately 16 to 18 hours after the egg cells and the sperm were incubated together, we evaluate whether the egg cells were successfully fertilised. In this process, the egg cells are gently removed from the "cumulus cells" (these are special granulosa cells surrounding and nourishing the oocytes). Whether fertilisation has been successful can be easily identified. Fertilisation has taken place if the oocytes have two so-called pronuclei. These are small grooves in the center of the egg cell that can be easily detected under the microscope. Pronuclei are only formed after a sperm cell has entered into the egg cell and both the sperm and the egg cell have begun to unpack their genetic material and have condensed in the centre of the egg cell. The male and female chromosomes have not begun to converge yet.

On the day of the fertilisation check the decision will be made as to which fertilized eggs are to be kept for the embryonic transfer, and also whether additional fertilised eggs should be saved for cryogenic conservation (see below).

The fertilised eggs which have been selected for the embryonic transfer are then further cultivated.

2 or 3 days later, the embryonic transfer takes place. With the help of a thin, flexible tube up to 3 embryos having reached the multi-cell stage are placed in the uterus. No anaesthesia is required for this procedure. This means that the couple can experience this special moment together.

Most couples find waiting to take a pregnancy test, which takes about 14 days, long and stressful. Nevertheless, aside from stimulating the production of corpus lutein hormones, all possible therapeutic measures have been completed and the nidation can no longer be influenced.

After blood sampling on the morning of the 14th day, you will know by noon whether your pregnancy has been successful.

ICSI - Intracytoplasmatic Sperm Injection

ICSI – Intracytoplasmatic Sperm Injection

This procedure involves a remarkable type of lab work within the scope of artificial insemination outside the human body.

In conventional IVF treatments, in which the egg cells and sperm and kept together in a liquid culture and stored in an incubator at body temperature, the sperms' journey to the egg cells proceeds naturally. In contrast to this, Intracytoplasmic Sperm Injection (ICSI) means that egg cells are carefully held under a microscope while individual sperm cells are injected directly into the centre of the egg cell using a thin glas pipette.

This intricate laboratory procedure is only recommended if the mobility of the sperm found in the semen is very low. The inability to get pregnant via conventional IVF is another reason for using ISCI.

Occasionally, despite good sperm quality, fertilisation is not achieved in the test tube. In such cases we would also recommend the ICSI procedure for the next treatment cycle.

TESE (Testicular Sperm Extraction)

TESE (Testicular Sperm Extraction)

If no sperm cells are found in the man's semen, it is often possible to retrieve sperm from his reproductive organs. In turn, these can be used for fertilisation outside of the human body, by using the ICSI method.

For cases requiring testicular sperm retrieval we work closely with the two andrologists on our team of professionals, Dr. Beckerling und Dr. Rembrink. We are also happy to work with other urologists if you wish.

The testicular tissues samples are retrieved during a procedure under a short anaesthesia which is performed at the andrologist's practise. While the procedure is being performed, our lab assistants will already begin processing the testicular tissue samples, in order to isolate the available sperm found in the semen canals and process them for freezing (cryopreservation). As a result, we can give the surgeon immediate feedback as to whether sufficient sperm have been retrieved. By doing so, we keep the time needed for the surgical procedure to an absolute minimum. Aside from retrieving sperm, the tissue sample also helps clarify why insufficient sperm are present in the semen. Therefore, samples are taken from both testicles, and sent to Prof. Schulze for testing in the Andrology department at the University Clinic Eppendorf in Hamburg.

Before leaving the urologist's practise the laboratory assistants will inform our patients of the outcome regarding the number and quality of the isolated sperm cells.

If you prefer to have the testicular tissue sample taken in a urology practise or hospital of your choice, we will gladly provide special containers for transporting the tissue samples to our laboratory. Subsequently, the tissue can be processed and cryogenic freezing can take place in our practise.

Cryopreservation

Cryopreservation

It is possible to store germ cells (egg and sperm cells) in liquid nitrogen at a temperature of -196°C for later use in order to achieve pregnancy.

Under the following key words you find information about the various possibilities provided by cryopreservation.

Cryopreservation of Unfertilised Egg Cells

In most cases, excessive fertilised ova won through the IVFor ICSI methods are frozen in order to preserve them for embryonic transfer later on. The advantage for the woman is that there is no need for her to undergo repeated ova extractions, in order to transfer an embryo.
The fertilized ova are frozen in the pronucleus stage, i.e. one day after follicle puncture, before the male and female chromosomes have merged. This is a difficult technique. It requires the ova to be cooled down slowly to prevent the typical crystal formation during the freezing process to a minimum. Fertilised ova have an 80% chance of surviving freezing and thawing.

Cryopreservation of Sperm Cells

In the same way it is possible to freeze and preserve sperm cells extracted from the seminal fluid or from the testicular tissue. Regardless of whether any sterility treatment may have already been started, we give you the option to freeze sperm samples if fertility is at risk. This may be the case, for example, for men who have to undergo chemotherapy or radiation treatment for cancer.
Chemotherapy or radiation treatment can damage the testicular tissue to such an extent that sperm can no longer be detected in the seminal fluid after the cancer has been cured.
If sperm has been cryopreserved and stored in a semen bank before a successful cancer treatment leading to lasting infertility, it will still possible to have a child, even many years later.
In some cases, the help of a reproductive medical specialist may be required, but physical paternity is still quite possible.

If semen was cryopreserved, a spermiogram should be made about six months after finishing the cancer treatment. If sperm production is still functioning, the frozen samples can be thawed and disposed of.
A multi-level security system prevents mix-ups and losses.

If desired, sperm cells may also be cryopreserved for men who work away from home for extended periods of time, for example, and cannot be present on the day the egg cell is extracted. This ensures that fertility treatment can still be carried out.

Cryopreservation of Egg Cells

Women now also have the possibility to protect their fertility although oocyte banking is not yet common practice. The reason is that the procedure is far more complicated than for men, and has so far only been used experimentally during the last few years. It calls for some 14 days of hormonal pre-treatment and follicle punction to extract the egg cells (which are also called ova or oocytes).
After cryopreservation and storage in liquid nitrogen at -196°C, these ova are available for assisted reproduction (IVF) later on. Thanks to modern freezing methods (vitrification), unfertilised egg cells survive freezing and thawing almost as well as fertilised cells. If the surving egg cells are to be used for assisted reproduction, it can be expected that about half of the egg cells will be fertilised.

More than 100 births have been reported worldwide after freezing unfertilised ova. We also offer vitrification of eggs, if required. Alternatively, it is also possible to freeze ovarian tissue, and we will be pleased to advise you on this.

A multi-level security system protects against mix-ups and loss.

 

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