Consultations

We would like to draw our dear Patients' attention to the current regulations, according to which assisted reproductive (reproductive) treatments cannot be performed in private institutions; cycle initiation can only be undertaken by a state-funded infertility center.

In cases of suspected infertility, it is important that the examination covers both the female and male partners simultaneously. The examination process generally takes about two months. In approximately 40% of cases, a female factor is identified, in 30% a male factor, and in almost 10% of cases, abnormalities are found in both partners. In the remaining 10%, either no cause can be identified, or although the abnormality is known from scientific research, there is currently no applicable diagnostic procedure or treatment available.

Female infertility examinations

• Routine gynecological examination: ultrasound, gynecological cancer screening, microbiological examinations (vaginal secretion culture, STD tests /Chlamydia, Ureaplasma, Neisseria, Gardnerella)
  
  
• Examination of the uterine cavity and fallopian tubes: The ultrasound device available at Duna Medical Center can spatially map the uterine cavity and the endometrium, as well as any possible abnormalities in the underlying tissues (polyps, myomas, septum, adenomyosis). It allows for a spatial representation of individual anatomical structures, which, with the help of advanced computer technology, can be viewed in rotation. The device is also capable of serial examination of arbitrarily set layers - similar to the operation of CT or MRI devices. In investigating unsuccessful pregnancies - when searching for deformities of the uterine cavity - it can also replace hysteroscopy. The patency of the fallopian tubes can also be assessed with ultrasound, but this requires the introduction of a visibly contrasting substance through a thin catheter (this procedure is called HYCOSY: HysteroContrastSalpingoGraphia). It is also possible to examine the elasticity of tissues: this helps to more accurately differentiate healthy tissues from pathological ones (e.g., detection of small endometriosis).
  
  
• Hormonal system examination: This involves checking the pituitary gland hormones that control the ovaries (FSH, LH), the ovarian hormones (estradiol, progesterone), the hormone indicating ovarian reserve capacity (AMH), the hormone responsible for lactation (prolactin), a detailed examination of the thyroid and any antibodies against it, the male hormone (testosterone) and its transporting protein (SHBG), the adrenal gland function (ACTH, DHEAS, cortisol), and the body's carbohydrate metabolism (possible insulin resistance). The latter is especially important in cases of high body mass index (BMI ≥ 25) and irregular, especially absent, menstrual cycles.
  
  
• Blood coagulation system examination (in case of suspicion): It is taken for granted that our blood is in a liquid state within the vessels, yet there are conditions (thrombophilias) where blood clots can form within the intact vascular pathway without injury. These pathological conditions can be congenital (the most known form is the Factor V Leiden mutation) or acquired. The latter are often associated with autoimmune conditions. In these cases, the patient may develop deep vein thrombosis or pulmonary embolism, especially during pregnancy or when taking contraceptive pills or undergoing hormone treatment (e.g., infertility treatments). In pregnancy, occlusion of the small arterioles running to the placenta can lead to placental necrosis, which in turn can lead to the termination of the pregnancy. Diagnosis requires a blood sample from the patient, which then needs to be sent to a specialized laboratory for analysis.
  
  
• Immune system examination: During the development of the immune system cells, those cells that attack the body's own cells and tissues are selected out. Nonetheless, unfortunately, there are conditions when the immune system attacks its own host organism, these are called autoimmune conditions. In such cases, the attack may target the placental cells, damaging their function; often, the coagulation system is also activated (acquired thrombophilias). These conditions can also be detected through blood tests, specialized (and usually very time-consuming) laboratory examinations. A special group of immune cells, called Natural Killer (NK) cells, is also examined. These cells can be detected from peripheral blood, but a subgroup of them is found in large quantities in the endometrium. If their number or activity increases, they can damage the developing placenta (essentially, NK cells decide whether the pregnancy can continue or not, they play the "executive" role in immune-origin miscarriages). There is also a test available to determine how the female body reacts to her partner's cells; this is called compatibility testing.

Male infertility examinations

• Andrological examination: This involves investigating any possible pathological abnormalities in the male genital organs. The most well-known is varicocele, or the varicose veins of the testes.
  
  
• Microbiological examination of semen: Culture and STD tests (as with women).
  
  
• Spermiogram: The volume of ejaculated semen, the number, concentration, movement, and shape of spermatozoa obviously all influence fertilizing capability.
  
  
• Special laboratory examinations: With their help, we can get a much more accurate picture of the fertilizing capability of spermatozoa, the future fate of the embryo. These include: sperm acrosome reaction, HBA test, sperm DNA fragmentation (SCSA), examination of reactive oxygen species (ROS) in semen, and it is possible to examine various substances produced by the immune system (interleukins). Our examinations can extend to anti-sperm antibodies possibly produced by the female partner, which can be detected from semen or the woman's blood.
  
  
• Hormonal examination: The same hormones are produced in men as in women, but in different ratios, or elsewhere, exerting different effects (e.g., FSH acts in the testes) accordingly, we examine FSH, LH, TSH, estradiol, testosterone, and prolactin levels. In the case of overweight, it is also worth examining possible insulin resistance or diabetes in men (an enzyme in adipose tissue can convert male sex hormones into female sex hormones-estrogen; obviously, this does not benefit male sexual function).

In both partners

In some cases - especially in the case of recurrent miscarriages or repeatedly unsuccessful IVF (in vitro fertilization) treatments - it may be necessary to examine the genetic material (chromosomes) of both the woman and the man (karyotyping).