Our treatment options

The woman's natural cycle is observed by means of ultrasound examinations and hormone tests. If egg maturation is disturbed or ovulation fails to occur, medication in tablet or syringe form can be given to support egg maturation.

By specifically triggering ovulation with medication, the best time for fertilisation can be determined and pregnancy can be achieved through normal sexual intercourse. The prerequisites are normal sperm quality and the patency of the fallopian tubes.

Insemination therapy as well as in vitro fertilisation and ICSI therapy are considered assisted fertilisation methods. These procedures increase the chances of fertilisation of the egg. The fusion of egg and sperm nevertheless remains a natural and very individual process. We decide which method is the right one in your case depending on your medical history and your findings.

The chances of becoming pregnant in the course of IVF or ICSI treatment depend to a large extent on the age of the patient. The pregnancy rate for a 35-year-old patient is 36 % after the transfer of an average of two embryos, and about 25 % for a 40-year-old patient. The miscarriage rate after IVF or ICSI therapy averages 20% (compared to 10-15% after natural conception) and increases with maternal age. This has a direct impact on the birth rate. This is 25% for a 35-year-old female patient and 15% for a 40-year-old female patient (source: DIR register). The conditions for pregnancy at a younger age are also more favourable with this method.

Insemination treatment can be useful in cases of mild sperm quality restriction, i.e. insufficient sperm concentration or sperm motility. With this method, too, the woman's cycle is observed by means of ultrasound and blood tests, if necessary with the help of medication, and ovulation is triggered at the most appropriate time.

On the day of ovulation, the partner provides a semen sample. This is prepared in the laboratory. This means that the seminal filaments with the best mobility and normal shape are significantly enriched. The prepared sperm cells are then transferred directly into the uterine cavity using a special catheter. This procedure is comparable to a gynaecological examination and is not usually painful.

Insemination treatment can also be useful after operations on the cervix, for example cone biopsies, as the migration of the sperm to the uterine cavity may be impaired here.

In vitro fertilisation is a method of artificial insemination. This means that eggs are taken from the female ovary and fertilised in the test tube with the male's sperm. In order to be able to remove a sufficient number of eggs from the ovary, the maturation of egg follicles is supported by hormone treatment for about two weeks. The mature eggs are then removed from the ovary in an outpatient procedure under a short anaesthetic and brought together with the prepared sperm cells of the man outside the body. If fertilisation takes place, one or two embryos are transferred into the uterus a few days later. This embryo transfer can be compared to a gynaecological examination and takes place without anaesthesia.

IVF therapy is useful if, for example, the woman is known to have an obstruction of the fallopian tubes and the eggs and sperm cannot come together naturally. Eggs and processed sperm are placed together in a dish, and the sperm fertilise the eggs without any further laboratory procedures.

ICSI therapy is an additional method of artificial insemination that is used in particular in cases of severe sperm quality restrictions. A single sperm is injected directly into each retrieved mature egg under a special microscope. If there are no sperm in the man's seminal fluid, an attempt can be made to obtain sperm directly from the testicles (TESE) or epididymis (MESA). This is only possible through a surgical procedure. If it is possible to find sperm, ICSI therapy is carried out.

(Modified) Natural Cycle IVF

Some patients refuse ovarian stimulation with hormones, cannot have stimulation treatment for health reasons or have had bad experiences with it (e.g. ovarian hyperstimulation). In principle, it is possible to perform IVF or ICSI therapy without or after very mild ovarian stimulation.

With natural cycle IVF, no drugs are used to stimulate follicle growth. Only a trigger injection is given to kick-start the final steps of oocyte maturation and allow better timing of the follicular sampling.

In modified natural cycle IVF, mild stimulation of the ovaries is carried out. Here, other (e.g. clomiphene) or much smaller amounts of FSH injections are given than in classical IVF treatment. Depending on the course of stimulation, so-called GnRH antagonists, which prevent premature ovulation, may also have to be given. Again, a trigger injection is needed to kick-start the final stages of oocyte maturation and better plan the timing of the follicular sampling.

Since the ovaries are not stimulated or are only mildly stimulated, only one or a few follicles usually mature. However, with natural cycle IVF, it is to be expected that in a high percentage of cycles (approx. 50 %) no follicle sampling occurs or no egg can be retrieved during follicle sampling. This can be explained by the fact that not every egg follicle matures into an egg. Ovulation also often occurs spontaneously too early in the natural cycle, so that follicle sampling can no longer be performed. It follows that younger patients with a stable cycle have significantly better chances of success with natural IVF.

The processes of follicular sampling, artificial fertilisation of the egg by the IVF or ICSI method and embryo transfer remain unchanged in natural cycle treatment. However, it is more often possible to perform egg retrieval without anaesthesia. Due to the lower number of eggs obtained, the pregnancy rate per cycle and also per embryo transfer is lower than with conventional IVF therapy with hormonal stimulation. However, with natural cycle IVF, it is possible to attempt egg retrieval in every cycle, as the ovaries do not need to recover from previous stimulation.

An important consideration is the cost situation. If your health insurance covers the costs of IVF therapy, it is often more beneficial to choose classical stimulation followed by IVF or ICSI. The overall chances of pregnancy per treatment cycle are higher when multiple eggs are retrieved, especially when methods such as prolonged embryo culture or cryopreservation of fertilised eggs are also used.

If a couple has a severe reduction in semen quality or azoospermia (the absence of semen in the ejaculate), it is possible to undergo treatment with donor sperm.
Depending on the findings, this can be used for insemination or IVF therapy.

Donor samples can be ordered from sperm banks. Donors are carefully screened for transmissible infections or hereditary risks and selected to match the couple as closely as possible.

We work together with the following sperm banks:

EUROPEAN SPERM BANK

TFP Sperm Bank

Cryostore Deutschland GmbH

ERLANGER SAMENBANK

CRYOBANK-MÜNCHEN

CRYOS INTERNATIONAL