If you and your partner are facing the impossibility of conceiving, you are not alone. Infertility is defined as the inability to conceive despite frequent unprotected sex for at least a year for most people and for six months in certain circumstances.
According to current scientific knowledge, between 10-15% of couples in the world have a problem with conceiving and achieving pregnancy.
WHEN TO SEEK HELP?
The recommendation of the World Health Organization is that if the couple does not become pregnant within a year with regular sexual intercourse, it is necessary to consult a doctor to determine the problem.
For couples over the age of 35, it is recommended to seek help even earlier, ie after 6 months of unprotected sexual intercourse.
WHAT ARE THE CAUSES OF INFERTILITY?
Infertility in women:
Cycle errors, anovulation 20-30%
Tubal damage 10-12%
Uterine abnormalities 5 - 10%
Unexplained (idiopathic) infertility 30%
Infertility in men:
Research has shown that the last 50 years have seen a significant reduction in sperm quality in men, and if we select by gender, it is 40-50% male factor.
Causes can be: lower sperm concentration, motility, morphology or DNA damage of sperm.
Environmental factors are sometimes responsible for the increased prevalence of infertility - frequent use of various chemicals and eco-pollutants greatly affect men's reproductive health.
Koji testovi postoje za utvrđivanje neplodnosti?
Tests to diagnose infertility include a complete medical history and physical examination of both men and women.
There is no single, best test or ideal test for infertility. In practice, more tests and examinations are needed to identify problems that may contribute to male and female infertility.
INFERTILITY TESTS FOR WOMEN
Most women are familiar with this basic gynecological test. Pap test and vaginal examination are the best ways to detect cervical cancer, other cervical problems or active sexually transmitted diseases. Any of these problems can interfere with a woman's fertility.
It is important to start treatment while the patient is healthy, because in case of existing problems with the cervix, it is not recommended to do any surgical interventions during pregnancy.
It is important that the papa test is done before starting to apply IVF treatment methods.
In order for a woman to get pregnant, the ovaries must release an egg every month (ovulation). Women who have irregular periods may need testing to determine if they are ovulating.
REPRODUCTIVE ORGANS TESTS
The uterus, fallopian tubes and ovaries must function well for a woman to become pregnant. The health of these organs can be checked by various procedures.
Also called HSG, it involves a series of X-rays that determine the condition of the fallopian tubes and uterus after injecting liquid dye through the vagina. HSG can help diagnose fallopian tube blockages and uterine problems. If one of the fallopian tubes is blocked, obstruction can be seen on an X-ray. HSG is usually done immediately after menstruation.
An ultrasound probe is inserted into the vagina, and with the help of sound waves, the ovaries and uterus can be recorded and the existence of follicles in the ovaries can be determined.
MALE INFERTILITY TESTS
SPERMIOGRAM (SPERM ANALYSIS)
We recommend that both partners come together for the first examination. In this case, the spermiogram is performed on the first day, along with other necessary examinations. The results are available in two hours. Sexual abstinence from three to five days is necessary before this test. If a man already has spermiogram results, it is enough to take them with him.
An in-depth physical examination can detect and give indications of hormonal problems. Testicular size can be measured. Ideally, a physical examination should be performed by a urologist.
Testosterone, like many other hormones, is produced in the brain, and this hormone controls sperm production. However, hormones are not a key problem in 97% of infertile men.
Men who have very few sperm, or no sperm at all, or after repeated IVF failures, need to undergo genetic analysis. This analysis is performed by taking a blood sample. Your doctor may request genetic tests in the form of chromosome analysis and / or a Y chromosome microdeletion test.
What is the difference between sterility and infertility?
Sterility is the inability of an individual or a couple to conceive, while infertility means that a couple, after succeeding in conceiving, is not able to bring the pregnancy to birth and give birth to a healthy baby.
All of our initial tests were in order. Why can't we get pregnant?
Initial testing is useful in detecting major problems such as low sperm counts or blocked fallopian tubes. Approximately 20-25% of patients with infertility will have regular test results (called "unexplained infertility").
This can be explained at least in part by the decline in fertility due to aging. We are often able to get additional information about why you did not get pregnant through intensive monitoring of our patients by our medical staff.
What is the difference between primary and secondary infertility?
Primary infertility refers to couples who have not become pregnant after at least 1 year of sexual intercourse without the use of birth control methods. Secondary infertility refers to couples who have managed to get pregnant at least once, but now cannot.
Can parental infertility be passed on to a baby?
Babies born as a result of assisted reproduction are like other children and do not have any additional health problems.
Can we have sex during IVF?
For the IVF / embryo transfer cycle (including frozen embryo transfers), we advise you to abstain from intercourse or use condoms during the treatment cycle until the pregnancy test to avoid high-risk multiple pregnancies from simultaneous natural conception.
For an IUI cycle, you may have unprotected relationships on the day of your IUI and beyond (but this is not necessary for the success of the cycle).
Is there a risk of having a child through in vitro fertilization?
It is important to recognize that the rate of birth defects in the general population is about 3% of all births for more serious malformations and 6% if milder defects are involved. Recent studies have suggested that the rate of more serious birth defects in children conceived by IVF may be 4 to 5%. This slightly increased rate of defects has also been reported for children born after IUI and for naturally conceived siblings of IVF children, so it is possible that the risk factor is inherent in this particular patient population rather than the technique used to achieve conception.
Research shows that children conceived by in vitro fertilization are on a par with the general population in academic success, as well as in behavior and mental health.
Do fertility hormones pose a long-term health risk?
Numerous studies have been conducted since 1992 when this issue was first raised. No one has found a link between fertility drugs and a higher risk of ovarian cancer. Preliminary results from an ongoing study by the American National Institutes of Health also suggest that there is no association between fertility drugs and ovarian, uterine or breast cancer.
The treatment was unsuccessful, when can I try again?
We advise you to rest your body for at least 2 months before starting a new cycle.
Where and how to give a sperm sample?
Sperm samples are delivered by masturbation and can be produced at the clinic where we can ensure that your sample will not be affected by any external factors prior to testing. Men who had difficulty making a sperm sample at the clinic would be advised to take a sperm sample at home or at a nearby hotel and transport it to us within an hour of production to maintain sustainability.
Should sexual intercourse be abstained before sperm analysis and after IUI (insemination)?
Please refrain from sexual intercourse 48 hours before giving a sperm analysis sample. There are no restrictions on sexual intercourse after IUI.
Can the day of my embryo transfer be predicted?
We need to make sure your fertilized eggs are sufficiently developed. By the third day, the embryos should divide into an eight-cell phase. Our embryologist will evaluate your embryos on a daily basis and decide which day would be ideal for embryo transfer. Since we cannot predict how the embryos will develop, the decision on when the transfer will be made will be made on the morning of the 3rd day after the collection of the ova. Our embryologist will provide you with daily updates on the progress of your embryos, including when embryo transfer is most likely to take place.
Should the bladder be full during emrion transfer?
Yes. When we start this procedure, we use ultrasound to examine your uterus to check the position of the embryo. A full bladder allows for a clearer scan, and also helps the embryo to be more easily placed in the uterus.
How long does embryo transfer take?
It takes about 30 minutes. Generally, there is no discomfort or pain during this procedure.
What is a blastocyst embryo?
A blastocyst embryo is an embryo that is 5-6 days old. Normal embryo transfer can be done on the 3rd day after taking the eggs, while the blastocyst is grown in our laboratory for the next 2-3 days in order to improve the selection. Our goal would always be to transfer blastocysts if you meet the criteria for the same.
What are the chances of pregnancy with frozen embryos?
The success of frozen embryo transfer procedures depends on three factors:
Quality and survival rate of frozen embryos. In general, we freeze only good quality embryos, so the current survival rate is higher than 90%.
The age of the woman from whom the ova originate. In patients under the age of 37, the chances of pregnancy with frozen embryos are similar to pregnancies with fresh embryos.
In patients older than 37, the chances of pregnancy with frozen embryos decrease in combination with a general decline in fertility, but they can still be quite good. As always, it is best to discuss the individual situation of the woman with her doctor.
Uterine status in a woman receiving embryos. A healthy endometrial mucosa without any interfering fibroids or polyps provides a healthy environment for embryo implantation.
How long do patients living outside Sarajevo have to stay at our clinic?
Many of our patients come from different parts of Europe and from all over the world. Those who started stimulation treatment from home will come to our clinic approximately 5-7 days later. Most patients must be in our clinic from 10 days to three weeks. Our staff is always available to help and advise patients outside the city during treatment, by phone or email.
Can I have a glass of wine during the treatment?
We suggest that you limit alcohol consumption during treatment and therapy and avoid consuming it during pregnancy.
Can I swim during the treatment in your clinic (sea, pool)?
Yes, without any problems.
Can I drink coffee during treatment or other caffeinated beverages?
It is recommended to limit the consumption of caffeinated beverages during treatment and pregnancy. (Less than 150-200 mg of caffeine per day)
How often does a couple need to have sex to achieve pregnancy?
After the ovum leaves the ovary it survives for approximately 48 hours and only during that time can it be fertilized by sperm that maintain their fertilization capacity for a maximum of 72 hours. In any case, it is better not to be obsessed with monitoring ovulation, because anxiety due to pregnancy is counterproductive for pregnancy, and can even damage the relationship in the couple. However, the probability of a spontaneous pregnancy after a year of trying is greatly reduced, even with careful planning of sexual relations.
By what age can men and women have children?
There is no legal limit that prevents a couple from trying to have a baby. Much depends on the circumstances of each couple, their health and physical condition, but also other factors. For women, 50 years is a reasonable limit beyond which infertility treatment is not recommended.
When can patients living outside of Sarajevo travel home after IVF treatment?
Most of our patients living outside Sarajevo return home the day after the embryo transfer because there is no medical reason to stay in our clinic after IVF treatment. All types of travel are safe. Sitting for a long time will not affect your chances of getting pregnant. We recommend that patients traveling by air drink plenty of fluids, as circulating air can be quite dry and dehydration should be avoided.
Does IVF use all female eggs?
A woman's ovaries contain hundreds of potential eggs. Each month, during the natural ovulation cycle, the ovary selects only one egg from a group of 100-1,000. Those eggs that are not selected go through a process of natural cell death called atresia. When a woman uses fertility drugs, the body’s natural selection process is overwhelmed, and the number of these otherwise unused eggs can increase. As many as 20 eggs can be stimulated in a given cycle. Therefore, when fertility drugs are used in the process of in vitro fertilization, not only does the woman not use all her eggs, but she ‘saves’ the eggs that would otherwise be subjected to atresia.