Vitro fertilization is needed when a combination of factors prevent the formation or development of pregnancy.

When is the right time to come to counseling for infertility?

– If you are trying to get pregnant for more than a year, should you decide to come to counseling for sterility/infertility/ infertility? If you are over 35 years, this period is 6 months.

Patients appeal to us first if:

Women

• You have between 35 and 40 years of trying to conceive for at least 6 months
• You have more than 40
• Do you have irregular periods or you do not do?
• You know you have a problem with fertility
• Have you had more than one abortion?
• You are being treated for cancer.

Men

• Do you have a low sperm count or other problems with the sperm?
• Do you have swelling in the scrotum (varicocele)?
• Have been doing a
• You had surgery on the scrotum or
• You have small testicles or problems with sexual function or
• Do you wish to know how much you are fertile?

Can lead to infertility only one cause, either you or your partner. Some combination of factors may prevent the formation or development of pregnancy.

There are safe and effective therapies for overcoming infertility problems that significantly increase the chance of becoming pregnant, such as:

• FSP and IUI – latest insemination
• from spontaneous IVF / natural cycle
• IVF with ovarian stimulation
• ICSI from spontaneous / natural cycle
• ICSI with ovarian stimulation

Thanks to Primo Vision Time Lapse monitoring system that is installed in the incubator now we can watch the development of new life.

By observing the development of the embryo camera Time Lapse VITROLIFE seen the creation of new life. Thanks to Primo Vision Time Lapse monitoring system that is installed in the incubator, we now have the opportunity to, together with the future parents monitor each phase of growth and development of the embryo, and that they do not bother you.

If we know that the incubator artificial uterus in which the control of carbon dioxide and oxygen is trying to “imitate” the rights of the uterus, then the layman clear that any opening of the door of the incubator, taking “will judge” in embryos and putting them under a microscope to determine the stage of development represents stress for embryos and can disturb the process of creating a new life.

Throughout the process control embryos remain in the incubator, protected from potential stress to which they are exposed without the use of the most modern ways of monitoring.

Counseling for infertility

In counseling, you will be kindly welcomed by our gynecologist. After an open discussion with you and your partner (if you come with it), our doctor will suggest further examination and treatment of infertility/fertility help you reach potential pregnancy. Therefore, the whole cycle is called biomedical assisted fertilization or abbreviated BMPO.

In order to prevent spontaneous pregnancy (without our help) should be:

1. Valid Clinical findings
2. Budget number and quality of sperm
3. The existence of ovulation (not menstruate does not have ovulation. Ovulation means that this month you have an egg)
4. The walk-on fallopian tube in which it comes to connecting the egg and sperm
5. The cavity of the uterus without the: partition wall, the polyp, myoma, and which may typically interfere with implantation of the fertilized egg
6. Do not have any infection in women and men

Prepare yourself for the first consultation with a gynecologist, which includes the exchange of information:

1. About the time when you started trying to get pregnant, how often do you have sex (especially mid-cycle ovulation)?
2. About your previous treatment (take a medical history, estimates, and opinions of doctors who have treated you and your partner)
3. The drugs, vitamins, herbal products, and other supplements you use (dosage and how often you take). As well as lifestyle (smoking, alcohol, drugs, exposure to toxins and

It is important that our doctor ask questions in order to jointly come up with a successful treatment procedure.

Examples of basic POA are:

• What are the reasons why we have not yet began?
• What tests are needed to be done?
• What method of treatment recommended for first?
• What are the side effects of the treatment you recommend?
• What is the probability of multiple pregnancies during treatment you recommend?
• How many cycles of treatment, this treatment will go through?
• If the first method of treatment fails, what do you recommend as the next step?
• Are there any long-term complications associated with this or other treatments for infertility treatment?

Do not hesitate to ask a doctor any questions that you are interested in.

The gynecologist may ask:

• How long have you had unprotected sex?
• How long is actively trying to get pregnant?
• How often do you have intercourse?
• Do you use any lubricants during intercourse?
• Do any of you smoke?
• Do any of you drink alcohol or take some recreational drugs? How often?
• Do any of you currently taking any medications, dietary supplements or anabolic steroids?
• Did either of you ever been treated by some diseases, including sexually transmitted infections?
• Are you at work or living environment exposed to chemicals, pesticides, radiation or lead?
• How much stress is present in your life?
• How satisfied are you with your connection?

Questions of our gynecologists only: Women

• When did you get your first period?
• What are your cycles?
• How frequent, long and plentiful?
• Did you follow the cycle and ovulation test?
• How many times?
• Have you ever been pregnant?
• What is your typical daily diet?
• Do you exercise regularly? How much?
• Do your body weight recently changed?

Men

• At what age you started puberty?
• Have you ever had sexual problems in a relationship, such as a difficulty in maintaining an erection, decreased sexual desire, premature ejaculation, or inability to ejaculate?
• Did you start a child with one of the previous partners?
• Are you treated for any type of cancer?
• Did you notice any swelling in the scrotum or around the testicles?
• Do you have brothers with the problem of infertility?
• Do you have an infection of the testicles, epididymis or prostate returning?
• Have you ever had surgery on the testes, prostate or pelvic area (such as testicular cancer or colorectal cancer)?
• Have you ever had a hernia in the groin?
• Have you had a vasectomy?
• Do you have chronic respiratory infections?
• Are you on any medication or taking any supplements to increase muscle mass?

Be prepared to answer all questions.

Your answers will help your doctor to quickly decide on the next steps in diagnosis and initiation of treatment.

Testing in women

The causes of infertility in women include:

• disturbances in ovulation that hinder or prevent the ovary to let egg. Examples include hormonal disorders such as polycystic ovarian syndrome, a condition in which your ovaries secrete too much can male hormone, testosterone and hyperprolactinemia having too much prolactin• the hormone which stimulates the production of milk in the breast. Other causes can include strenuous exercise, eating disorders, injuries or
• the occurrence of abnormalities in the uterus or cervix include problems with opening or cervical mucus in the cervix or abnormalities in the shape or cavity of the uterus. Benign tumors in the wall of the uterus are common but rarely cause infertility by blocking the fallopian More often disturb implantation of a fertilized egg.
• damaging or blockade of the fallopian tubes are usually formed as a result of inflammation of the fallopian tubes (salpingitis). Do these infections can cause pelvic inflammatory disease caused by sexually transmitted infections, endometriosis or
• Endometriosis occurs when endometrial tissue from growing or growing outside the This condition often

affects the functioning of the ovaries, uterus and fallopian tubes.

• Primary ovarian insufficiency is often called early menopause, as the ovaries stop working and menstruation disappears before the age of 40 Although the cause is often not known, certain conditions associated with early menopause such as immune system diseases, radiation treatment or chemotherapy, and smoking.
• Priraslice pelvis, strips of scar tissue, which binding observed after infection of the pelvis, appendicitis or surgical procedures in the abdomen, or pelvis.

Other causes in women include:

• Problems with the thyroid. The malfunctioning thyroid gland, whether it is too light (hyperthyroidism) or too little (hypothyroidism) thyroid hormones, may interfere with the menstrual cycle and cause infertility.
• Cancer and its Certain cancers, particularly cancers of the female reproductive organs, often seriously endanger the woman’s fertility. Radiation and chemotherapy can also affect the ability to reproduce.
• Other conditions. Medical conditions related to delayed puberty or absence of menstruation (amenorrhea), such as celiac disease, Cushing’s syndrome, sickle cell disease, kidney disease or diabetes may affect fertility žene. Genetic anomalies may also reduce the possibility of conception and pregnancy.
• Certain medications. The use of certain drugs can cause temporary In most cases, fertility returns when they stop taking their medications.

Risk factors

Some risk factors are the same in men and woman.

They include:

• Age – woman’s fertility gradually declines with age, a decline accelerating from the middle Infertility in older women is related to the number and quality of oocytes due to the very old, and because of the health problems that can affect fertility. Men over 40 years old may also be less fertile than younger men.
• Tobacco use – a couple is less likely to get pregnant if at least one partner uses tobacco. Smoking also reduces the potential benefits of treatment for infertility. Miscarriages are more common in women smokers. Smoking in men can increase the risk of erectile dysfunction and low sperm counts.
• Drinking alcohol – women no safe amount of alcohol that can be taken during conception or Avoid alcohol if you want to get pregnant because you may not know the first few weeks that you have already pregnant. Drinking alcohol increases the risk of congenital deformities, and can complicate getting pregnant. In men, consuming large amounts of alcohol can reduce the number and mobility of sperm.
• Overweight, inactivity and being overweight increases a woman’s risk of In obese men may be a problem with the number of sperm and testosterone Niva.
• Inadequate physical masa.Woman who have an eating disorder such as anorexia and bulimia, or bring too few calories can have fertility problems.
• Exercise – decreased physical activity contributes to obesity, which increases the risk of Less commonly, problems with ovulation can occur due to frequent, arduous and too intense exercise in women who are not obese.

Testing women:

• 32%> ovulatory problems
• 26%> oviduct
• 32%> ovulatory problems
• Abnormalities cavum – a significant contributing factor to the increase in frequency

Gynecological history:

History of menstruation:

• Regular menses (24-35 days)> ovulation in 97%
• Oligo / amenorrhea> high probability anovulation
• Previous pregnancies and outcome
• History of STD
• History of contraception
• Pelvic surgery
• Weight change
• Endocrine diseases (e.g., hypothyroidism)

Clinical review:

• Height and weight
• Identification of thyroid abnormalities
• Secretion from breast cancer
• Hirsutism and other signs of hyperandrogenism
• The classical gynecological examination

Testing in men

Medical history:

• Congenital anomalies of the genitals
• cryptorchidism
• delayed puberty
• erectile dysfunction
• Herniorrhaphy, especially in childhood
• mumps
• STD
• genitourinary surgery
• Metabolic / neurological conditions
• Drugs, alcohol, and drugs
• Lung disease, upper respiratory infection
• Possible genetic syndromes (Young’s Sy, Kartagener’s Sy – immotile cilia, cystic fibrosis)

Clinical examination:

• Secondary sexual characteristics> distribution of hair, gynecomastia, constitution
• Genitals
• Localization of urethral meatus
• Testicles> volume (12-30mL – Praderov orchidometer), consistency
• Epididymis
• Size, position, orientation
• Texture> cističnost, nodularity> possible obstruction due to infection or inborn
• Vas deferens
• CBAVD (Cong. Was. Absence of you def.)> Cystic fibrosis (CF mutation transmemb. Conductance regulator gene)
• Spermatic cord> DG varicocele
• Gr I – palpable only with Valsalva maneuver
• Gr II – without a Valsalva maneuver
• Gr III – visible
• Rectal examination> TU prostate, seminal vesicle cysts

Laboratory:

• Sperm> after 2-7 days of abstinence

First step:

If the couple does not live in Serbia, it is possible to do down that analysis, if everything is all right, that with all the findings come just before obtaining the woman’s cycle to a doctor who would work in vitro did I ultrasound (to see that there is a cyst which is an annoyance for the start of ovary ovarian stimulation).

The necessary analysis and diagnostics for women:

1. Microbiological tests: vaginal smear – bacteriological and mycological cultures, cervical smear test Chlamydia, Mycoplasma, and Ureaplasma
2. HBsAg, HCV, HIV, VRDL-serology
3. Toxoplasma gondii, Rubella-serology
4. screening of the cervix (cervical smear test, colposcopy)
5. ultrasound performed vaginal probe
6. hormone test, which is made from the second to the fourth day of the start of menstrual bleeding (FSH, LH, E2, Pg, T, Prolactin, a hormone-Antimilerijan AMH), TSH, T3, and T4
7. of the general preparation immediately prior to the procedure, blood type, Rh factor, complete blood count, a urine test, biochemical analysis, a small factor of coagulation (PT, INR)

The necessary analysis and diagnosis for men:

• microbiological tests: urethral swab bacterial and mycological cure, urethral swabs to chlamydia, mycoplasma and the Ureaplasma;
• spermogram and spermoculture

After you submit the required analysis, in consultation with our experts we’ll get back to you that you can do with

stimulation immediately after the next cycle or require specific therapy, additional analysis or medical intervention.

In the event that everything is all right we scheduled dates of commencement of stimulation. I stimulation process

takes 10 to 15 days, depending on the condition (ovulation it is the finest drug: Gonal F, Menopur, Cetrotide, Ovitrelle).

After injection stop (Ovitrelle) for the aspiration (removal of oocytes), if everything is fine and fertilization occurs, it is

Embryo (return fertilized ova-embryos) at 2-3 days of aspiration.

It would be best to set aside a period of 3-4 weeks to remain in Serbia.

If fertilization does not work after the first attempt, it is possible to repeat the procedure after two months.

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