Here at TFP, we know that whether you’re embarking on your first fertility journey or even just considering fertility treatments, it can be a daunting experience into the unknown. That’s why we are here to be your guide each and every step of the way.

TFP has over 30 years of experience working with patients just like you. So, believe us when we say we know how important it is for you to understand fertility treatments and terminology.

A

Abortions / premature abortions / habitual abortions

Abortions are the medical term for miscarriages. These are more frequent than one might think: it is now assumed that every second pregnancy ends as an abortion. Since these are usually very early miscarriages (often in the 4th week of pregnancy), many women do not notice the miscarriage.

Premature abortions

We call such miscarriages biochemical pregnancies: the pregnancy hormone is detectable in the blood, but no embryo is visible in the ultrasound. As soon as a pregnancy is visible in the uterus, the miscarriage rate decreases: 15% of all clinical pregnancies (pregnancies seen on ultrasound) end as miscarriages.

Probability of abortions

The probability of miscarriage increases with the age of the woman: from the age of 40, every 2nd pregnancy will end in miscarriage. The reason for this is miscarriages of the egg or the embryo, which lead to genetic errors. In the case of severe genetic errors, the embryo cannot develop further, so that an abortion occurs.

Habitual abortions

Habitual abortions are when a couple has had three or more miscarriages. Fortunately, only 1% of all couples are affected. For these couples, a precise clarification is very important.

The following examinations are recommended for clarification:

• Genetic examination of both partners: With the help of a blood sample, the chromosomes (i.e. the genetic make-up) can be examined. If there are any abnormalities, IVF and a subsequent trophectoderm biopsy can help.

• Hysteroscopy (endoscopy of the uterus): During a hysteroscopy, septa, fibroids or adhesions can be seen, which can lead to abortions. These can be removed during the procedure.

• Clarification of coagulation disorders: Antiphospholipid syndrome can be a cause of habitual abortions. This can be determined with a blood sample.

• NK (natural killer) and plasma cells: Chronic inflammation in the uterus can also lead to habitual abortions. This can be determined with the help of a tissue sampling. This sampling can also be done as part of the hysteroscopy.

Diagnosis and treatment in our fertility clinics

In our fertility clinics in Vienna, Wels and Klagenfurt, our reproductive medicine experts get to the bottom of the unfulfilled desire to have a child with comprehensive diagnostics. With our own diagnostic laboratory, cryobanks and sperm bank, we can offer you the entire spectrum of fertility tests (hormones, genetics, immunology), fertility treatments and other supportive treatments.

F

Fertility

Fertility refers to a woman's ability to become pregnant or a man's ability to father children. In contrast, sterility is when a couple has not become pregnant for over a year despite regular sexual intercourse. Infertility is when a woman becomes pregnant but is unable to carry the pregnancy to term.

Examination for the man

Spermiogram.

A spermiogram examines the number, motility and appearance of the sperm. In a normal spermiogram, there should be 15 million sperm, 32% moving forward and 4% normally shaped. Lower numbers have a negative effect on fertility.

If sperm count is severely reduced, genetic testing and counselling should be done to identify health risks for a child.

If no sperm can be found in the ejaculate (azoospermia) even with repeated tests, a testicular biopsy (TESE) can help.

Examination for the woman

Hormone status. This blood sample, which should be taken between the 1st and 5th day of the cycle, determines the following hormones:

• FSH and LH:  Control of the cycle

• Oestrogen: Influence on oocyte maturation.

• Prolactin: milk production. An increase can lead to cycle disorders.

• TSH: control of the thyroid gland

• Androgens: Testosterone, DHEA, androstenedione: Decreasing these hormones can be useful in cases of androgenisation, e.g. increased hair growth.

• AMH: Oocyte reserve

In addition, progesterone can be determined in the second half of the cycle to rule out luteal insufficiency. 

In the case of fertility problems, hormone treatment or, if this is not successful, IVF treatment can often help the woman.

Follicle, follicular puncture

A follicle is the shell of an egg cell. As an egg matures, the follicle grows until it reaches a size of about 2cm. Then ovulation occurs and the mature egg is released. In a normal cycle, several follicles mature to a size of about 1cm, after which one follicle asserts itself and continues to mature while the others regress. IVF treatment can take advantage of this fact: With the help of hormones (FSH, LH), the other follicles also continue to mature, so that several mature eggs can be obtained.

Follicle puncture - procedure

The retrieval of the eggs in an IVF treatment is done by follicle puncture. Under a short sleep anaesthetic, the doctor retrieves the eggs by puncturing the ovary through the vagina with the help of a thin needle and sucking out the follicles and thus the eggs they contain.

This is done under ultrasound control to prevent injury to surrounding organs. The procedure usually takes 10 to 15 minutes, complications (injury to organs, bleeding, inflammation) are very rare.

After the procedure, the patient is monitored in a recovery room for another hour, after which she is allowed to leave the clinic. Most patients do not need any pain medication after the procedure and can go straight back to their normal daily lives.

The eggs collected during the follicular puncture are taken to the IVF laboratory where they are fertilised.

H

HyCoSy

HyCoSy is the name given to hysterocontrast sonography (HKSG), a diagnostic procedure using ultrasound to gently check the permeability of the fallopian tubes.

When is a HyCoSy performed?

The patency of the fallopian tubes can be checked in three ways: via laparoscopy (laparoscopy, an operation), hysterosalpingography (HSG, an X-ray examination) or contrast medium sonography (HyCoSy).

Since many women do not want to have an operation or an examination with radiation, many opt for HyCoSy. This examination can be carried out easily and painlessly at our clinic.

However, before a HyCoSy is performed, the spermiogram should be checked: If the spermiogram is limited so that pregnancy cannot occur naturally and ICSI (link) is necessary, a HyCoSy should not be performed, as the fallopian tubes are not needed in the context of artificial insemination.

HyCoSy procedure

HyCoSy is performed in the 1st half of the cycle, as the mucous membrane offers better visibility here and a pregnancy that may already exist in the 2nd half of the cycle cannot be affected. The doctor disinfects the vagina and then places a thin catheter in the uterus. Under ultrasound control, a fluid is flushed through the catheter, which glows white in the ultrasound. The doctor can see directly whether the fallopian tubes are open or not. The examination takes a total of five to ten minutes.

A prerequisite for carrying out a HyCoSy is that there is no infection in the vagina, as there is a risk of germs being carried into the fallopian tubes and the abdominal cavity through the flushing of the fluid. If there is an infection in the vagina, this should be treated before a HyCoSy is performed.

If the fallopian tubes are blocked, pregnancy can only occur with the help of IVF treatment.

I

Implantation failure

If a woman has received three embryo transfers of good embryos in the course of IVF or ICSI treatment without pregnancy occurring, this is called implantation failure or repeated implantation failure (RIF).

The causes can be manifold, so comprehensive diagnostics are advisable.

We recommend the following examinations

• Hysteroscopy (endoscopy of the uterus): During a hysteroscopy, organic changes such as septa, fibroids or adhesions can be seen which may prevent implantation of the embryo. These can be removed during the procedure.

  
  

• Clarification of coagulation disorders: Antiphospholipid syndrome can be a cause of implantation failure. This can be determined with a blood sample.

  
  

• Genetic examination of both partners: With the help of a blood sample, the chromosomes (i.e. the genetic make-up) can be examined. If there are any abnormalities, IVF and a subsequent trophectoderm biopsy can help.

  
  

• NK (natural killer) and plasma cells: Chronic inflammation in the uterus can also lead to implantation failure. This can be detected with the help of a tissue biopsy. This sampling can also be done during hysteroscopy.

  
  

• Immunological examination: Here, an immunological blood test with precise analysis of antibodies and immune cells can be useful.

  
  

• ERA test: The ERA test is used to determine the implantation window. For most women, the implantation window is five days after the start of progesterone administration, but it can be shifted forwards or backwards. This can be determined by a tissue sample and subsequent analysis.

T

Tubal occlusion (fallopian tube)

The term tubal occlusion refers to an occlusion of the fallopian tubes (Latin: tuba uterina). The fallopian tubes are important for getting pregnant naturally, as fertilisation takes place in the fallopian tube. The sperm enter the fallopian tube through the vagina and uterus, the egg is released from the ovary during ovulation and is collected by the fallopian tube. If fertilisation occurs, the embryo travels to the uterus over 5 days, where it implants on the 6th day.

Causes

The cause of tubal occlusion is usually infections. One of the most common infections here is chlamydia: 3-10% of the population are affected. Since the infection is often asymptomatic, many affected people are not treated. Chlamydia is transmitted through sexual intercourse. If a chlamydia infection is diagnosed, the partner must therefore always be treated as well. In the meantime, there is a screening for chlamydia in Austria: every woman under 35 years of age receives a smear test once a year as part of the preventive medical check-up at the gynaecologist in order to detect chlamydia.

Another cause of tubal occlusion can be endometriosis. In this case, there are often pronounced adhesions, which then lead to tubal occlusion.

Diagnosis and treatment

The patency of the fallopian tubes can be checked during a HyCosy. If the fallopian tubes are blocked due to an infection or endometriosis, surgery with an attempt at reconstruction is usually not advisable, as the inner structure of the fallopian tubes, the cilia, are also damaged. IVF is then the recommended therapy.

Which positions are advantageous if you want to have children?

During sex, positions should be used that minimise the leakage of semen from the vagina. The ventro-ventral position, also known as the "missionary position", is the most common position for humans. Standing or sitting positions tend to be unfavourable when trying to conceive.

In our fertility clinics in Vienna, Wels and Klagenfurt, our specialists can both diagnose the fallopian tubes and find a suitable fertility treatment for you.

U

Hyperstimulation syndrome (OHSS)

In the context of IVF, hormone therapy is necessary to obtain more than one egg and thus increase the chances of pregnancy. It is important here that the hormone dose is adapted to the patient and her egg reserve in order to avoid side effects. A woman's egg reserve can be determined with the help of the AMH value and an ultrasound. If the dose is still too high, it can be lowered during the course of therapy. Overstimulation syndrome (OHSS) is when there is an overproduction of eggs during hormone therapy.

Symptoms and risks of overstimulation

Severe overstimulation syndrome can be life-threatening without proper treatment and therapy, but fortunately less than 1% of all patients are affected by this form. Dangers of overstimulation include thrombosis, accumulation of water in the abdomen, lung cavity and tissues, and in very severe cases liver and kidney dysfunction.

Early and late overstimulation

There are two forms of hyperstimulation syndrome: an early form that results from the injection used to induce ovulation and a late form that occurs in the context of early pregnancy.

The early form can be prevented by using a drug to trigger ovulation in patients who have a large number of follicles, which does not lead to OHSS.

The late form can be prevented by not performing a fresh transfer in a patient at risk of OHSS, but by freezing all embryos. A transfer can then take place in the next cycle. Freezing does not harm the embryos; the chances of pregnancy are even better with frozen embryos than in a fresh cycle.

Therapy

If OHSS occurs, thrombosis prophylaxis with heparin injections is essential. In addition, the patient should drink plenty of fluids and ensure adequate protein intake. In the case of a pronounced OHSS, monitoring in a hospital is necessary.

Nowadays, the risk of OHSS can be greatly reduced by precisely adjusting the dose of hormones to a patient's egg reserve, ultrasound checks during hormone therapy and the freezing of embryos.

V

Transport to the Optimum (VZO)

For pregnancy to occur, sperm must be in the fallopian tube at the time of ovulation. Since an egg can only be fertilised for 24 hours, the right time must be chosen. This is called cycle monitoring and intercourse to the optimum, or VZO for short.

When are the fertile days?

There are two ways to find out exactly when you are ovulating: Testing the hormone LH, which leads to ovulation, in the urine or ultrasound checks. If LH is tested, a rise (positive test) indicates that ovulation is imminent. The day the test shows positive is the optimal time for sexual intercourse.

If cycle monitoring is carried out by a doctor or at our fertility clinic, an ultrasound is usually performed between the 9th and 11th day of the cycle. The doctor sees whether a follicular vesicle has formed and can thus predict when ovulation will occur and thus the optimal day for sexual intercourse.

A prerequisite for pregnancy with the help of cycle monitoring is that the fallopian tubes are open. This can be checked during a HyCosy.

How often should you have sexual intercourse during the fertile days?

In principle, it is sufficient for a healthy couple to have sex 2 to 3 times a week in order to become pregnant in the foreseeable future. This can be optimised by having intercourse at the optimum time. If the fertile phase is imminent, intercourse can also take place every day. It is important not to lose sight of the pleasure factor in order to counteract compulsion and thus avoid feelings of guilt, which can put a strain on the partnership.