State-of-the-art diagnostics, innovative techniques, service and safety - Kinderwunschzentrum Dresden fertility clinic.

Abnormalities in the area of the cervix, which interfere with the ascent of the sperm into the uterine cavity, can also be the reason to plan intrauterine insemination. Depending on the indication, the chance of success with this procedure is between 10 and 15 percent per cycle. Intrauterine insemination is a simple therapy with few side effects, but it should be performed no more than three to four times, as there is little chance of success after that.

If there is a desire for treatment with donor sperm, we will first inform you about the various treatment options (insemination versus IVF/ICSI therapy) during an initial consultation. The decision on the type of treatment depends on various factors, such as tubal patency, the female cycle and the age of the woman. We cooperate with Berliner Samenbank GmbH, Cryos International Samenbank and European Sperm Bank.

Before signing a contract with the sperm bank and starting treatment with us, legal and psychosocial counseling are required by law. German health insurance companies do not cover the costs of these therapy procedures.
Since 2018, the Sperm Donor Registry Act has been in force and creates legal certainty in this area. A nationwide sperm donor register has been established at the German Institute for Medical Documentation and Information (DIMDI). Accordingly, persons who were born by means of a sperm donation have the right to know their own parentage at the age of 16.

In this procedure, the ovaries are hormonally stimulated by injections that can be self-administered at home, so that several eggs mature. Approximately 36 hours after ovulation is triggered with a hormone injection (e.g. hCG), the eggs are aspirated through the vagina under a short anesthesia. For this purpose, a vaginal ultrasound examination is performed. With the help of a guide rail attached to the ultrasound head, the puncture needle can be precisely guided through the upper end of the vagina directly into the ovary in order to aspirate the follicular fluid with the oocytes from the follicles. Due to the permanent ultrasound control this is done very gently, complications are very rare.

After the sperm has been delivered and the ejaculate has been prepared by washing and centrifugation, the oocytes and sperm are brought together in a special nutrient solution (photo). The sperm penetrate the eggs without further assistance. The fertilization rate can vary greatly with this method.

The fertilized eggs continue to develop into embryos through cell division:

• Day egg puncture + 1 = pronuclear stage.
• Day egg puncture + 2 = 2-4 cell stage
• Day egg puncture + 3 = 6-8 cell stage
• Day oocyte aspiration + 4 = berry stage (morula)
• Day oocyte aspiration + 5 = vesicle stage (blastocyst)

We recommend this treatment only under certain conditions. In the majority of cases, PICSI will not be necessary. We will advise you on this in our consultation. You can also obtain further information from the manufacturer's flyer, which we provide at the Kinderwunschzentrum Dresden fertility clinic.

During development in the incubator, it is essential to inspect the oocytes at specific times. These microscopic examinations, which are kept as short as possible, can provide information about the correct course of development. Deviations from the normal course can be detected and support the selection of the optimal oocytes. Logically, during a conventional microscopic examination, the cells are not in their optimized environment in the incubator. Therefore, these examinations must occur as infrequently as possible, and the time spent outside the incubator must be kept to a minimum. Several years ago, incubators were developed that elegantly circumvent this problem. In these devices, the oocytes are observed via video microscopy in the incubator. Every single egg cell is photographed in the infrared range at intervals of a few minutes, so that continuous observation is possible without disturbing the cells. The result of this continuous monitoring is a time-lapse video recording of the development of each individual egg cell. This provides the embryologist with a whole new source of information for assessing development. These devices are now used in numerous centers. International research has led to completely new evaluation criteria that can be applied when using this technology. Such a device is also available in our center. In addition to the extensive information obtained by evaluating the time-lapse images, this device provides absolutely stable culture conditions. In 5-minute intervals, 7 photos are taken of each oocyte in different focal planes. The exposure time is only a few milliseconds each time. The "photo light" is in the infrared range, which prevents any influence on the cells.

The advantages of embryo culture in the Miri-TL incubator:

• optimal, completely undisturbed culture conditions from treatment to embryo transfer
• close monitoring of cell development by built-in video microscopy
• information about dynamic morphological events by time-lapse videos.

Studies have shown an increase in the implantation rate, a reduction in the early abortion rate and thus an increase in the continuous pregnancy rate.
The costs for this additional service are not covered by the German statutory health insurance. The additional costs are due to the material costs associated with this technique, as well as the additional daily cytological assessment of the recorded cell development.

However, there are several factors that can prevent this "hatching", such as hardening or thickening of the zona pellucida. If the embryo does not manage to leave its envelope, implantation in the endometrium is naturally ruled out. This problem can be avoided by "thinning out" the zona pellucida in one place. This is done by means of a laser, which creates a kind of predetermined breaking point in the zona pellucida. This additional service is called "Assisted Hatching". This procedure definitely does not harm the embryo, this has been shown in various studies. Nevertheless, "Assisted Hatching" is not useful in every patient.
We recommend "Assisted Hatching" only for patients over 36 years of age, after multiple unsuccessful embryo transfers, or for cryo-transfers. The variant "Hatching on demand" is becoming more and more popular with our patients. Here, the laboratory decides whether the treatment is useful, e.g. because the zona pellucida is too "thick" or too "firm".
We will discuss which variant makes sense for you in a personal consultation.

The operation is usually performed in advance of the planned ICSI therapy. The tissue samples are examined for suitability by microscopy and then frozen (cryopreserved). Ideally, any piece of testicular tissue can be used to perform ICSI therapy. The combination of ICSI treatment with TESE can make it possible to conceive even in cases where no sperm are found in the ejaculate. Such a complex therapy is possible only through close cooperation with a urologist. In many cases, consultation with an experienced human geneticist prior to therapy is also useful. Further information on urological issues can be found, for example, at our cooperation partner "Urologische Gemeinschaftspraxis Dresden-Friedrichstadt".

In individual cases, sperm freezing may also be planned before longer absence of the male partner. The frozen sperm can then be used for ICSI therapy or insemination therapy, depending on the initial situation.
The testicular tissue obtained during a TESE (see also there) or the sperm obtained in this way can also be cryopreserved and used for a subsequent fertility therapy. If more oocytes are fertilized in the course of IVF or IVF/ICSI treatment than planned for embryo transfer, such "surplus" fertilized oocytes can also be cryopreserved. If necessary, they can be thawed, cultured and transferred into the uterine cavity as an embryo at a later stage - this allows pregnancy to occur without having to go through all the steps of IVF or IVF/ICSI therapy again. The procedure is proven to increase the pregnancy rate in relation to egg retrieval.

For long-term sperm storage we collaborate with Air Liquide Healthcare Cryobank. 

As a woman ages, her egg reserve decreases and the quality of her eggs declines. In addition, age affects the likelihood of malformations and miscarriages, as well as the rate of pregnancy complications.

Social freezing can increase the chances of pregnancy at a later stage. In this treatment procedure, healthy unfertilized eggs are retrieved at the earliest possible time and gently "frozen" using a process called vitrification. This freezing at a young age protects the eggs from aging and preserves your fertility even at a later date.

Best results with social freezing are achieved in women who are younger than 30 years of age at the time of egg retrieval and for whom a total of at least 25 - 30 eggs can be frozen. As in a regular IVF or ICSI cycle, the ovaries must first be hormonally stimulated. This usually takes 10-12 days. After that, the eggs are collected under a short anesthesia, vitrified and stored in liquid nitrogen.