Choosing the Right Treatment Method
Determining the causes of infertility of otherwise healthy couples requires various types of medical tests, but just basic discussion with a specialist and the first examination can relieve psychological pressure and bring new hope, fortitude and the will to be treated.
For easier communication, the initial interview can start by filling out a personal questionnaire with specific questions related to the patient’s relevant health condition, previous diseases, operations, pregnancies and infertility treatments, also menstrual cycle quality etc.
Which treatment are you willing to undergo? Some agree to taking pills but most do not agree to injections. Others are willing to undergo insemination but not insemination outside the body (IVF). Yet others are willing to undergo anything except an egg and sperm donation. Moral principles and spiritual beliefs can have an important effect on choosing the right treatment method.
That is the reason why after analyzing the initial information, the physician will determine the schedule of examinations and subsequent treatment, which is then continuously updated based on the gathered information and changes in the treated couple’s position with regard to the treatment.
The actual gynecological examination is performed to (a) exclude congenital developmental defects, presence of inflammation, benign cervical tumors (myoms), polyps and (b) examine the condition of cervix and the character of the endometrium. Screening for causes of inflammatory diseases and oncological cytology are also often included in the procedure. An ultrasound examination is also performed.
The male patient is thoroughly examined via a sperm analysis. If any fundamental abnormalities are identified in the results or in the general health condition, a urological examination is recommended.
Blood tests to determine hormonal profile, blood type, Rh factor, sexually transmitted diseases and hepatitis testing, and possibly additional individualized blood tests, are an absolute necessity.
The couple can also be recommended some additional testing – genetic and immunologic tests, post – coital test (PCT), MAR test and other specialized tests.
Based on the actual results, imaging or endoscopic (hysteroscopy, laparoscopy) examinations can be performed, mainly to determine the fallopian tubes patency or to remove cysts, causes of endometriosis, polyps, myomas, uterine septum, etc.
The treatment plan is then updated based on the collected information.
Ovulation induction and insemination (IUI) is a basic treatment procedure. In the Czech Republic, insemination may be covered by health insurance for up to six times per calendar year. If the IUI proves unsuccessful, IVF is usually performed. In the Czech Republic, assisted reproduction treatments are funded by public medical insurance based on the recommendation of the specialist (assisted reproduction physician) for:
1. Women between 18 – 39 years of age with blockage in both fallopian tubes
2. Other women between 22 – 39 years of age. IVF is covered by medical insurance only three times during the lifetime, which means maximum of four monitored cycles with stimulation and, in those cycles, maximum of three cycles with an embryotransfer. After depleting all three insurance covered cycles, the next attempt is fully paid for by the treated couple. Also many of the non-standard tests and procedures are not covered by the insurance – ICSI, AH, elongated cultivation, PGD, MESA, TESE and others.
Detailed description of IVF protocol can be found in: In vitro fertilization, outside the body fertilization (IVF).