We take a lot of time for you during the first meeting. Here we will already discuss the first diagnostic and therapeutic steps with you.
Which therapy is best for you?
First of all, a targeted diagnosis is necessary. After the diagnostic results, we will present you an optimal treatment in a further step. The aim is to work with you to find a successful path to the desired result – pregnancy.
We carry out various treatment methods in our center:
The cycle monitoring
The term »cycle monitoring« stands for the observation of the cycle. The aim is to precisely determine the time of ovulation in order to be able to narrow down the fertile phase of the woman as closely as possible.
Depending on the natural length of the woman’s cycle, the first examination is usually carried out on the 10th – 12th day of the cycle. In the ultrasound, the maturing follicle (follicle) and its state of maturity can usually be seen well, as well as the mucous membrane of the uterus, which increases in height in the middle of the cycle.
They also allow conclusions to be drawn about the maturity of the follicles. The growing follicle produces estradiol, the blood level of which can be used to estimate the time until ovulation. The determination of the »luteinizing hormone« (LH), which triggers ovulation in the mature follicle, provides additional information about the approaching ovulation. In addition, a blood sample one week after ovulation is often useful to determine the level of the corpus luteum hormone.
The secretion of the cervixchanges depending on the cycle and becomes thin and clear immediately before ovulation and can be pulled into threads between two fingers (“spinnability”). The entrance to the cervix opens before ovulation, so everything is done to make it easier for the sperm to enter. A gynecological examination can easily determine these factors.
If the compatibility between the cervical secretion and the sperm is examined at the optimal time the following morning after sexual intercourse has taken place, this is known as a post-coital test.
Using medication to improve egg maturation is often a valuable aid in supporting a woman’s fertility. It is necessary when there are hormonal disorders that impair the growth of the follicles, but a functioning cycle can also be optimized with mild hormonal support.
In IVF treatment, it is given routinely to allow several egg cells to mature. Tablets (clomiphene) or syringes are available for this treatment. With the tablets there is an advantage due to the simple application, the syringes are more complex to handle, but contain the body’s own hormones, which is why the mode of action is more natural. Since the medication only needs to be injected under the skin, this can also be done by the patient or partner without any problems.
After an ultrasound to exclude cysts on the ovary, the hormones are given daily for several days and then the effect is checked using ultrasound and blood samples. It is also possible to have some of these examinations carried out by the gynecologist on site. When the egg cells are mature, ovulation is usually triggered with medication in order to better limit the time of ovulation.
After ovulation, natural luteal hormones are often given to improve the structure of the uterine lining and thus the implantation of the embryo.
The insemination (semen transfer)
With insemination, at the time of ovulation, the sperm are inserted directly into the uterine cavity with the help of a thin catheter. For this purpose, the sperm are prepared beforehand so that only sperm that can move well are used. A hormone pretreatment to stimulate or support the follicle maturation and to trigger ovulation increases the chance of success.
Moderately reduced sperm cell quality
Disruption of sperm transport
abnormal post-coital test
decreased mucus formation in the cervix
Need for treatment with foreign sperm (missing sperm in partner)
In vitro fertilization (IVF)
After hormonal stimulation of the follicle maturation (1) , mature egg cells are obtained from the ovaries by means of an ultrasound-controlled extraction (2) (puncture). They are then brought together with the partner’s prepared sperm cells in a test tube (in vitro) outside the body (3) . 18-24 hours later, the formation of two pronuclei (male and female pronucleus) shows whether a sperm has penetrated the egg cell and fertilization has taken place (4) . Up to three egg cells in the pronuclear stage are then further cultivated. Several cell divisions occur within the next 24 hours (5) .
After 2 – 3 days, the matured embryos – usually in the four to eight cell stage – can be transferred back into the uterine cavity (embryo transfer) (6) .
Transport disorder of the fallopian tubes
Idiopathic (= unexplained) sterility after unsuccessful pretreatment
Intracytoplasmic Sperm Injection (ICSI)
A single sperm is injected directly into the egg cell using a microcapillary under the microscope. This then enables fertilization and nuclear fusion. In this way, pregnancy can be achieved even if only a few and / or immobile sperm are available.
This method of treatment is even more promising if the extraction of a few sperm cells from the testicles or epididymis is only possible through a surgical procedure. As a matter of general caution (higher risk of genetic reproductive disorders in this treatment group), prior genetic counseling and examination of the affected couples is recommended.
Before the actual ICSI, i.e. the injection of the sperm thread into the egg cells, the procedure is the same as for conventional test tube fertilization (IVF). Here, too, hormonal pretreatment with subsequent removal of the egg cells is necessary, and after fertilization, the egg cells are also cultivated until the embryos are returned.
Severe reduction in male fertility.
Failure to fertilize with IVF despite good egg and sperm quality.
Closed vas deferens (occlusion azoospermia) after sterilization or congenital malformations. This is where the sperm are surgically removed from the testicles (TESE) and then the ICSI.
Missing sperm in the ejaculate with testicular damage, so-called testicular azoospermia (e.g. after undescended testicles, mumps disease in adulthood, etc.). Here, too, the sperm for the ICSI are surgically obtained.
Cryopreservation – freezing eggs
The Embryo Protection Act only allows up to three embryos to be returned to the uterus. If more eggs can be fertilized after the egg retrieval than are intended for the later transfer, the excess fertilized eggs can be frozen.
Since the survival rate after thawing is around 70%, cryopreservation is only recommended in exceptional cases if there are fewer than three excess egg cells. The advantage of freezing excess egg cells is that further hormonal stimulation and egg retrieval are not necessary in order to have a new chance of conceiving. The disadvantage is that the costs for such a procedure are not borne by the health insurance fund and the pregnancy rates are well below the results with “fresh” embryos.
The decision for or against freezing is made the day after egg retrieval, when the number of fertilized eggs and their quality can be seen.
In addition to egg cells, you can also freeze sperm. This happens, for example, with the surgical removal of sperm from the testicles, but also with men who have to undergo chemotherapy due to a malignant disease and who want to keep the possibility of later fulfilling their desire to have children open.
How to reach the Kinderwunsch Zentrum Kassel
Fertility Center Kassel
at Klinikum Kassel GmbH
Mönchebergstrasse 41 – 43 (House F)