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Počalji od Erata taj 15/3/2013, 10:41

Obzirom da postoje teme o pojedinim klinikama, ova tema bi mogla da posluži kako bi se prikupile informacije o raznim klinikama u inostranstvu, koje su manje poznate i popularne kod nas. Ja sam pre par meseci poslala upite na više adresa u inostranstvu i njihove odgovore ću postaviti ovde. U tim odgovorima su sadržane korisne informacije o postupcima i cenama na tim klinikama. Takođe, ovde se mogu razmenjivati i lična iskustva sa klinika na zapadu, pošto ima mnogo naših cura na forumu, koje žive i rade u inostranstvu, pa su svoje postupke obavljale tamo.
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Počalji od Erata taj 15/3/2013, 10:44

Klinika GENNET, Prag, Češka

Dear.....,

Thank you for your enquiry and interest in GENNET. My name is Pavla Rathousová and I’m an IVF coordinator. From now on, I will be your contact person providing you with all the information that you need and if you decide to come to our centre I will be there to help you.

We are the leading clinic for genetics, fetal medicine and IVF in the Czech Republic, welcoming several hundreds of international patients each year. We have an extensive genetics programme offering PGD from our diagnostic laboratory, genetic testing and genetic counseling services. Our clinics perform in excess of 2500 IVF cycles each year offering the latest technology including real-time continuous monitoring of embryos using Embryoscope. We also provide all new techniques including IVM, PICSI, IMSI and egg and embryo vitrification. We have our own in-house donor sperm and donor egg programmes. For comprehensive diagnosis, we offer office hysteroscopy without anesthesia.

Our physicians have the experience of thousands of cycles and international patients enjoy treatment from our multilingual personnel.

Our IVF laboratories are accredited in accordance with the recognized International Standard ISO 15189:2007. In addition our IVF clinics are ISO 9001:2009 certified.

Please allow me answering your questions as follows and rest is normally answered on the initial consultation, so if you would like to arrange 1st consultation with our IVF doctor, I would love to do it.

The stimulation phase can be monitored also by your gynecologist back home: In this case, you would need to visit our clinic for the initial consultation and again for the egg retrieval and embryotransfer. Most of our patients will stay in the Czech Republic between egg retrieval and embryo transfer, this would imply a stay of 2-6 days. If you wish so, we can contact also directly your doctor during the stimulation stage, as we will need the results of your ultrasounds during stimulation (2-4 ultrasounds).

1.Travelling involved

a) Initial consultation – preferably both partners. Initial consultation in our clinic will take approximately one hour.
b) Oocyte retrieval – arrival preferably the night before, as OPU takes place very early in the morning
c) Embryo transfer

2.Succes rates
Success rates are now approximately 40% across all age groups.

3. IVF/ICSI package:
The fee for an IVF/ ICSI package is EUR 1,900 and includes

- Consultation and ultrasounds during treatment cycle
- Tests for HIV, Hep B, C and Syphilis for both partners at the time of egg collection
- Egg retrieval under general anesthesia
- Sperm analyses and sperm freezing of male partner
- Fertilization ICSI, cultivation up to blastocyst, ev. assisted hatching
- Embryotransfer
- Cryopreservation of all remaining embryos ( classic slow freezing )
- Storage of cryopreserved embryos/eggs for 1 year

STEPS OF PAYMENT

EUR 900,00 is payable on the day of egg retrieval.
EUR 1000,00 is payable on the day of embryo transfer or freezing. In case that embryo transfer does not take place, the remaining amount will not be counted.

Price does not include medication required before and during the stimulation and embryo transfer. For cycles interrupted before egg retrieval, only the initial consultation and medication are charged.

The fee for the initial consultation EUR 100 is payable on the day of the consultation. This amount is deducted from the treatment costs.

Additionally you may choose:

Permanent monitoring of embryos using EmbryoScope EUR 300
PICSI EUR 150
IMSI EUR 727
Vitrification EUR 242

4. Process:
If you have a Fertility Specialist at home to perform ultrasound scans you might require only one trip to Prague. The initial consultation can be done by telephone / Skype.

Initial consultation
The initial consultation in our clinic has two parts. Consultation with the doctor, which lasts approximately one hour. During this session the doctor discusses your medical history with you, prepares a personalized treatment protocol, and performs a trans-vaginal scan of your womb and ovaries.

The second part of your first visit consists of a consultation between you and your personal IVF coordinator, who discusses all non-medical questions and treatment planning.

After the first consultation the doctor will confirm whether treatment can take place (if you do not attend GENNET for the first visit, we require confirmation from your local Fertility Specialist).

5. Miscellaneous :
- According to Czech legislation, we can offer treatment only to heterosexual couples.
- Your husband/partner must appear in person to sign the documents – if not, we will require his notarized signature.
- The maximal age for females is 49 years.

I would be happy to welcome you as our patient at GENNET and hope that this email has given you an initial overview and has answered your questions. I am at your disposal for any further questions you may have. If for some reason I'm not here, my colleagues from International Patient Office will always be aware of your case and needs.

With my best Regards,

Ing. Pavla Rathousová
IVF Coordinator
cell: + 420 724 947 001

International Patient Office
The GENNET ART Centre
Na Poříčí 26
110 00 Prague 1
Czech Republic

Tel.: +420 242 456 782
Fax.: +420 242 456 787

E-mail: ivf@gennet.eu
www.gennet.eu

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Počalji od Erata taj 15/3/2013, 10:49

MEDICAL TRAVEL, Prag, Češka

Dear....,

Here you have also more detailed information from my father Dr. Milan Mrazek. He is one of the best IVF specialists in the country with more than 16 years of experiences. He checked also your email and he wrote this:


- If you don't have any geetic diseases in your family it's not necessary to make genetica test at this moment.
- it will be good to make autoimunne tests
- spermiogram is good. I recommend to male ICSI for some oocytes
- AMH is little bit lower.
- I recommend to make trombofil mutations
- I'm missing ultrasound of ovarium between 2-5 day of the menstruation. I need to see follicles count to set doses for the stimulation.i

Here you have some answers:


Please describe what would be the procedure for IVF treatment in your clinic – from consultations to the embryo transfer?- It depends on the woman period. If the first consultation is done shortly before menstrual bleeding, embryotransfer could be expected in next 3-4 weeks
What method of IVF do you recommend for us?- It will depends on the total number of retrieved oocytes. If less than five, ICSI is recommended even in a normal result of spermiogram. If mor oocytes, ICSI is used for fertilization in a half of them
What is the complete price for the IVF treatment (including all necessary steps and all recommended procedures for our case, from the start to the end of embryo transfer), without medicines?

What protocol and medicines do you recommend for me? - Ovarian controlled stimulation is in most cases in a protocol with GnRh agonist. We use recombinant FSH (Gonal F or Puregon) in doses from 150 to 300 IU daily, from the day 6 together with Cetrotide 0,25 od Orgalutran, Ultrasound examination is done on the day 7 of stimulation and later every the second day till at least two bigest follicle 17 mm in diameter, when hCG (Ovitrelle or Pregnyl) is administrated. Oocyt retrieval is performed 34-36 hours after hCG administration in a short general anesthesia by transvaginal follicle punture unde ultrasound guidence.
What is the maximum number of embryos transferred per one cycle?2 embryos in the maximum-
Do you practice the permanent embryo monitoring with embryoscope?Yes, contual embryodevelopement could be done by Primovision equipment.
What is the estimate date to begin the procedure, based on the attached information and your schedule and availability? Maybe November 2012?
Expected beginning of my menstrual cycle is about 15thNovember.
- It would be recommended to meed about 5 days befor menstrual cycle, IVF treatment could be finalized with embryotransfer in the begening of December.

Do you recommend us to use some vitamins or herbal products prior to IVF treatment?- Nosifol 1x1

Feel free to ask any questions


Best regards
MUDr. Martin Mrázek
MEDICAL TRAVEL
www.medicaltravelczech.com
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Počalji od Erata taj 15/3/2013, 10:56

ISCARE, Prag, Češka
Dear ...,
Thank you for your mail, I will try to answer all your questions.
I would like to make appointment with you in October, approximately one month before your IVFcycle
Please take all your results especially your operation protocol, hormonal profile and spermiogram.
I will do vaginal ultrasound examination to exclude potential problems and complications during IVF cycle and
I will decide about stimul. protocol and what drugs and doses you will use.
I will prescribe the protocol and according this one you will apply injections. (Our nurses will explain you all about aplication)
Usually I prescribe protocol with antagonist (medicaments Menopur, Cetrotide) which you will start to apply from 2nd day of your period (16 th November?) every day once daily and ultrasound scan could be performed 8th or 9th day of your period in Iscare. After two or three days later I will retrieve eggs under short (10 min.)
aenestezie (you will need pre-oper.examination) Embryotransfer one or two embryos (according their quality and your decision) will be done after 2 maximally 5 days (prolonged cultivation)
So it means, you can spend 1 day for consultation and one week during IVF procedure in Prague.
I recommend you IVF cycle with prolonged cultivation and/or embryo monitoring with camera (selection the best embryo) and freezing remaining embryos.

IVF cycle incl. medicaments 2700 eur
IVF cycle without medicaments 2000 eur
Prolonged cultivation 200 eur
embryo-monitoring 120 eur/ day (usually 2 days)
cryoconservation of embryos (3 years) 600 eur

Complete price list is in our web sites

So I expect, your complete price without drugs will be maximally 3000 eur ( depend on lab. procedures)

We prefer embryotransfer one maximally two embryos, pregnancy rate is 42% for one IVF cycle in your age (in our clinic)

Dear ..., I recommend you to eat especially natural vitamines and to start IVF cycle fresh, healthy ( after short holiday :--))
I promise you to care about you from the beginnig to the end of the treatment (pregnancy)

The best regards,

Jaroslav Hulvert MD, Head Physician of IVF Department, ISCARE


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Počalji od Erata taj 15/3/2013, 10:58

IAKENTRO, Atina, Grčka

Dear ... ,

We would like to thank you for your interest in our clinic .

We read your exams and we saw that the Hormone Prolaktine (PRL) is in
high level which should be repeated twice (one blood test now and one
more after 20 minutes) . Are you afraid when you give blood? Because
the fear maybe increases the PRL hormone. If the results are normal
means that the PRL was increased because of fear . If the results are
still in high levels , then we suggest you to do "cervical MRI" to
check if there is an adenoma in pituitary.

As far as your fertility problem is concerned , we saw that the Anti-
Mullerian Hormone (AMH ) is in a low level which allow us to
characterize you as a poor responder though your young age. If you get
pregnant with your own oocytes , the risk of miscarriage is about 70%
and we consume that by the low AMH result .

Your personal gynecologist what suggests you to do?

We are always at your disposal and kind to help you ,

Best Regards ,

Marina Nikoli
IVF Coordinator
0030-2106179340

Antoniou Kostantinos
Οbstetrician - Gynecologist


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Počalji od Erata taj 15/3/2013, 11:01

PRAGA MEDICA, Prag, Češka
Dear Ms...,

Thank you for your enquiry. As requested I am sending you the necessary info on IVF with ICSI including the cost and the possible treatment plans. Unfortunately I have not had time to answer your specific questions, but I will do so in a separate email next week. I hope you will be able to find some answers in the information below.

IVF with ICSI in Prague

Our Fertility Treatment program in Prague (the capital of the Czech Republic) is based on a close cooperation of a medical tourism facilitator PRAGA MEDICA with a top centre of reproductive medicine GEST IVF. The clinic was established in 1996 and since then more than 5000 healthy children have been born after successful infertility treatment.

There is no waiting list for IVF. Your initial consultation can be arranged as soon as in 1 week. You can either have the preparation done back at home with your local gynaecologist or you can come here for the complete Treatment. The necessary blood tests (STD, hormonal levels of AMH, Prolactin and TSH) for both partners, several ultrasound scans as well as the personal assistance of a local representative are included in the base price. These are the basic treatment options:

1.Complete IVF cycle in Prague (1 – 2 visits)
The woman resides for approx. 13 – 20 days, residence of partner may be minimized to 1 day.
You can download the detailed info here (PDF)

2.IVF cycle in cooperation with your gynaecologist (usually 2 visits)
The first visit may be managed in a single day. The 2nd visit takes 5 - 9 days, residence of partner may be minimized to 1 day.
You can download the detailed info here (PDF)

Should you not get pregnant after the 1st cycle we offer 10% discount on the 2nd attempt. If there are frozen embryos left the cycle with FET is just 484 EUR.

I have prepared for you an informative quote. The basic price includes the complete IVF cycle with highly recommended ICSI, including all basic examinations. The sample package includes also the most favourite recommended related procedures and medication.

Basic Treatment Only

EUR
GBP
USD

COMPLETE BASIC TREATMENT CYCLE OF IVF+ET
€1 980
£1 650
$2 750

ICSI - up to 10 oocytes
€352
£293
$489

General anaesthesia (egg retrieval)¹
€132
£110
$183

Transfer to the clinic for the 1st appointment:
FREE
FREE
FREE

Local representative to help during your whole stay:
FREE
FREE
FREE

Price of Treatment only*
€2 464
£2 053
$3 422




Sample package including other typical costs (optional)

Package details
EUR
GBP
USD

IVF stimulation drugs
€1000
£833
$1389

Prolonged cultivation of embryos (above 48 hours)
€140
£117
$194

Assisted hatching – each embryo
€132
£110
$183

Embryo glue
€66
£55
$92


Price of sample package*
€1 338
£1 115
$1 858


*Price in foreign currencies is just informative. Used conversion is 18 CZK per 1 USD, 25 CZK per 1 Euro and 30 CZK per 1 GBP. Exchange rate valid in the time of payment will be used for billing.
1) Before the egg retrieval you will need to present a medical report from your doctor confirming you are in good health. If you wish, we can provide the General health exam in Prague for 132 EUR

Total costs depend on your choice of a specific treatment plan. 7 days of accommodation in a nice apartment close to the clinic and the city center is 490 EUR in high season (April – October). Our service package including up to 8 transfers between the airport, accommodation and the clinic and the Czech mobile phone is just 90 EUR when booked with accommodation. Our service package is just optional and can be tailored according to your preferences.

NEXT STEP - online medical questionnaire

I would ask you to fill our online medical questionnaire. The details from the questionnaire will be examined by doctor Daniel Alexander or doctor Monika Polakova. They speak good English and have a lot of experience dealing with international patients. Once they find you suitable for the treatment, we will arrange your 1st consultation. It should take less than 5 minutes and is free of charge.
Please click here to access the questionnaire.

In case of any further questions, please do not hesitate to contact me.

Warm regards

Zdenek

Zdenek Dvorak
International Patient Coordinator
Prague
PRAGA MEDICA Ltd.
info@pragamedica.com
www.medicalservicesprague.com
Prague line: +420 228 880 995
Skype: praga_medica
Call us for local rate!
From Ireland: 01 554 72 08
From UK: 0845 528 11 90



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Počalji od Erata taj 15/3/2013, 11:03

PRAGA MEDICA

Dear Ms ...,


I hope you received my email from Friday. Please find my blue answeres to your questions below. Some questions are better to be answered on the phone. I will call you after 16:00 to explain more.

1. Please describe what would be the procedure for IVF treatment in your clinic – from consultations to the embryo transfer?
To be explained on the phone

2. What method of IVF do you recommend for us?
Probably the standard IVF with own eggs, with stimulation and fertilization by ICSI. To be clarified with the doctor during the initial phone consultation

3. What is the complete price for the IVF treatment (including all necessary steps and all recommended procedures for our case, from the start to the end of embryo transfer), without medicines? We are also interested in embryo freezing.
Complete IVF cycle with ICSI, Prolonged cultivation of embryos, Assisted hatching (1 embryo) and embryo glue is about 2802 EUR. You will need to bring from home a General Health Examination or it can be done here for 132 EUR. Embryos freezing, if applicable is 148 EUR.

4. What protocol and medicines do you recommend for me?
To be clarified with the doctor during the initial phone consultation

5. What is the maximum number of embryos transferred per one cycle?
2 is standard, 3 is max.

6. Do you practice the permanent embryo monitoring with embryoscope?
Yes, embryo monitoring is available for 60EUR per day, but it cannot be booked. The clinic rent it on first comes first served basis.

7. What is the estimate date to begin the procedure, based on the attached information and your schedule and availability? Maybe November 2012?

Expected beginning of my menstrual cycle is about 15th November.
If you want, we can start even earlier. To be explained on the phone

8. What is the success rate for “our case group” in your Clinic?
About 45%, Our success rate is fully comparable to other top European fertility clinics, for comparison please check your personal chances on the independent www.IVFpredict.com
9. Do you practice that one doctor leads patient from the beginning to the end of the treatment?
It is our aim

10. Do you recommend us to use some vitamins or herbal products prior to IVF treatment?
Not really, it does not make much difference, if you want to use something specific, please ask the doctor during the initial consultation

11. Do you recommend any specific activities or anything which can improve our chances for success?
ICSI, Prolonged cultivation of embryos, Assited hatching and embryo glue will increase your chances.

Kind Regards,
Zdenek

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Počalji od Erata taj 15/3/2013, 11:05

PRAGA MEDICA

Dear Ms ...
Doctor Alexander has evaluated your medical questionnaire and he believes you are a good candidate for Complete IVF Cycle + ICSI in Prague. He does not see any obstacles.

Other medical details will be discussed during the initial consultation with the doctor. I will be happy to call you and explain more about the organization of your medical trip, just please let me know when you are available.
The next official step to your treatment would be the initial consultation with the doctor where your treatment can be planned in detail. Your medical questionnaire or other medical reports you have provided would be discussed. There are several possibilities now:

1.Single visit treatment. Your initial consultation can be done by phone so you do not have to come here before the actual treatment. After you would stay here for about 3 weeks.
1.2-visit treatment = your personal consultation in Prague would be done during the 1st visit. As little as 1 day in Prague is necessary. The advantage of 2 visits is that you will stay here altogether less than 2 weeks (it can be done in 10 days). On the 1st visit the woman can be examined by a gynaecologist and further tests or laboratory works can be done and you can also buy the medication here. Also, partner’s sperm can be tested or frozen for future use. If the partner prefers to sign the documentation and have his blood tests he does not need to return to Prague later.

Please let me know which option you prefer. At this stage we also ask for the initial deposit of 250 EUR. It can be paid by a bank card or through PayPal. By sending this payment, you confirm your interest in treatment with us (our partner clinic GEST) and you will officially become our patient. From that point the doctor will be also able to answer your questions.
This advanced payment will be discounted from the total price of the treatment. Please let me know whether you agree and I will send you the reservation/payment details.

Please feel free to contact me in case of further questions.

Kind regards,
Zdenek

Zdenek Dvorak

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Počalji od Erata taj 15/3/2013, 12:10

PRAGUE IVF INTERNATIONAL

Poštovani ...,

Hvala što ste nam se obratili i za objašnjenje izloženo u pismu.

Pišem Vam u ime Dr. Kulta. koji je detaljno obavešten o svemu što ste naveli.

Medjutim nismo našli dokumente koje pišete da ste priložili. Da li čekate na rezultate analiza (osim serologije) ili ste možda greškom zaboravili da ih priložite?

Pre svega da bismo mogli da sastavimo protokol stimulacije kao i odgovorimo u potpunosti na sva vaša pitanja potreban nam je nalaz sa poslednjeg ultrazvučnog pregleda male karlice kao i rezultat hormonskog statusa pre svega FSH, LH i AMH i rezultat histeroskopije koja je radjena pre kao što pišete 6 dana.

Takodje da bismo Vam preporučili konačno metoda otrebno je da znamo i kakav je spermogram.

Na osnovu svih rezultata bi§e odredjen protokol stimulacije i sastavljen plan lečenja.

Ipak najoptimalnijim programom se smtra program sa dodantim metodama PICSI i kultivacijom u embrioskopu, kao i vitrifikacijom.

Dole Vam šaljem opis koliko sve to košta i cenovnik. Listi čekanja trenutno nema, ali je važno da znamo da li ...ima redovne menstruacije, kada je imala poslednju menstruaciju, da li koristi neke lekove, kontracepciju itd. Možda je najzgodnije da se čujemo tlefonom ili putem skajpa ukoliko želite da vam detaljnije objasnim proceduru. Takodje mogu vam dogovoriti video konsultaciju putem skajpa sa Dr. Kultom, samo morate da nas obavestite nekoliko dana unapred zbog rasporeda.

U tom smislu zamolila bih Vas da popunite kontakt obrazac i navedete sve tražene podatke (ukoliko ih znate), da bismo mogli konkretnije da pričamo o otimalnom programu lečenja:

http://www.fertility-ivf.eu/sr/kontakt-formular.html

Cena VTO /ICSi sa sopstvenim jajnim ćelijama pacijenta košta 1800 evra + oko 800-1000 evra lekovi za stimulaciju jajnika (cena lekova zavisi od vrste i pre svega doze leka koja vam bude potrebna)
Zamrzavanje prekobrojnih embriona košta 300 evra ukoliko se radi pomoću vitrifikacije (to je noviji i brži metod, koji pri odmrzavanju kasnije daje bolje rezultate), ukoliko se radi putem sporog zamrzavanja onda je uključeno u osnovnu cenu tj, besplatno je. Preporučuje se ipak vitrifikacija, naročito ako su preostali embrioni već u stadijumu morule ili balstociste.

Svaki sledeći pokušaj ukoliko prvi ne uspe ili želite eventualno drugo dete košta 700 evra (dolazite samo na transfer embriona). Radi se prenos prethodno zamrznutih embriona koji su dobijeni tokom prve stimulacije tj. vašeg prvog svežeg ciklusa.
Očekujem više informacija i dokumente sa ispitivanja.

Unapred hvala.
Srdačan pozdrav,

Marija Ćulibrk
Glavni koordinator IVF programa
Tel. +420728889922

Inače samo još da dodam da se pre planirane trudnoće preporučuje upotreba folne kiseline (ženama naravno) ili prenatal vitaminskih tableta. Kod muškaraca kod smanjenih vrednosti spermograma se obično daje profertil.
Medjutim s obzirom da ne znamo kakav je spermogram ni UZ, molim Vas da najpre popunite obrazac i dostavite analize, pa onda možemo obaviti i online konsultaciju.

Hvala još jednom.

Srdačno,

Marija Ćulibrk


Poštovana Marija, hvala vam na svim informacijama.
U dokumentu koji sam poslala nalaze se svi moji UZ rezultati u zadnjih godinu dana.
Zadnji je rađen nedavno, pred operaciju. Rezultat histeroskopije je da je postojao subseptum, koji je tom prilikom otklonjen.
U međuvremenu su stigli rezultati mikrobiološke analize uzorka endometrijuma: nisu nađene aerobne niti anaerobne bakterije, kao ni gljivice.
Još uvek čekam histopatološki nalaz, ovde se to dugo čeka. Rezultat spermograma rađenog u junu sam takođe poslala.
Trenutno sam na hormonskoj terapiji, koja mi je prepisana nakon histeroskopske intervencije (otklanjanje subseptuma).
U sledećem ciklusu verovatno neću imati realni pokazatelj hormona (zbog terapije), tako da planiram u oktobru da ponovim sve hormone.
Rezultate hormona rađenih u maju, takođe imate u dokumentu.
... će ponoviti spermogram (i on pije neke preparate), ja hormone i UZ, uradićemo serologiju. Nakon toga ćemo popuniti vaš upitnik.
Hvala i sve najbolje

Poštovana ...,

Hvala na objašnjenju oko histeroskopije. Ipak moram da Vam kažem da u vašem prethodnom mailu nisu stigli nikakvi rezultati. Da li nam možete poslati dokument o kom pisete (UZ i rezultate u zadnjih godinu dana). Mi nismo nista primili !!! Jer u vašem prošlom kao ni ovom mailu nije bilo tog dokumenta. Proverite molim vas ili pošaljite ponovo. Hormonksi status u maju.

Molim vas da nam napišete i koja terapija vam je data posle odstranjivanja subseptuma.

Hvala.

Srdačan pozdrav,

Marija Ćulibrk

Poštovana Marija,


Ja sam u prvom javljanju poslala word fajl u attachment-u, u kojem je napisano apsolutno sve. Od osnovnih podataka, preko hormonskog statusa, otpusnih lista iz bolnice, rezultata UZ, do spermograma.
U dokumentu sam sve rezultate prepisala. Mislila sam da je tako lakše za analizu, da sve prepišem i da bude u jednom dokumentu.
Sve što nije na latinskom, ja sam prevela na engleski. Vi očigledno niste otvorili taj fajl i pročitali ste samo mail, tj. kratki uvod.
Sad vidim da sam pogrešila u prethodnom mailu. Hormoni su rađeni u junu, 11.06, ali sam u maju krenula sa pripremama za HSG.
Terapija nakon histeroskopije je takođe napisana u fajlu. Šaljem vam ponovo attachment.
Ja sam se potrudila da napravim jedan pregledan i uredan dokument, umesto da šaljem originalne rezultate i pišem nepovezanu priču.
Na rezultatima je većinom sve na srpskom jeziku i neupotrebljivo je za strance.
A ja upravo tražim stranu kliniku i tim koji će se potruditi da ova moja borba uspe.
Ona traje godinu i 3 meseca, a trajala bi godinama da nisam odlučna. Puno sam odradila za ovih par meseci, sve na sopstveno insistiranje.
Sada sam u fazi izbora klinike, iako ovde imam 3 besplatna pokušaja. Ne želim da stojim u redu, dok vreme prolazi.
Medjutim, vidim da je tesko i na ovaj nacin odabrati. Uz duzno postovanje, ali niste jedini koji mi traze rezultate, a sve lepo pise.
Ipak, ima i onih koji su sve detaljno pogledali i zahvalili se sto sam tako lepo sve poslala da nema sta da se misli.
Sve najbolje.

Postovana ...,
Vas prvi mail nisam citala samo ja vec i Dr. Kult.
Ne znam o cemu se tacno radi, ali u prilogu koji ste poslala je bio samo kratak uvod.
Hvala sto ste ponovo poslala dokument i mada obicno prednost dajemo originalima, bez obzira na kom su jeziku (ovde to imamo dosta dobro reseno, a verujte imamo pacijente iz raznih evropskih zemalja od Italije do Skandinavije i nikad nije bilo problema), posto sam sada prosla ceo att. koji ste kako kazete ponovo poslala mislim da su podaci izneti u njemu pregledni i iscrpni.
Predacu ih sutra na uvid Dr. Kultu i napisati Vam ako mu bude potrebno jos nesto.
Smatram da svoj posao radim veoma savesno i odgovorno 6 dana u nedelji, skoro 12 sati dnevno (s obzirom da smo pacijentima uvek na raspolaganju).
Ipak imate svu slobodu da formirate misljenje o necijem radu, kao i da birate kliniku onako kako vi smatrate pravilnim.
Jos jednom naglasavam da ako imate neke sumnje ili nepoverenje, moguce je dogovoriti online(skype) konsultaciju sa Dr. Kultom,
da se upoznate kao i da direktno razjasnite sva pitanja koja vas muce, jer ce Vam on licno sastaviti protokol i raditi transfer.
Postovanje,
Marija Culibrk

Postovana Marija,

Nije problem da se sve skenira i posalje.
Ono sto cemo mi svakako ponoviti je: hormonski status i spermogram.
Posebno cu ponoviti AMH, verovatno jos sutra. Taj rezultat varira od laboratorije do laboratorije. Za spermogram takodje, velike su razlike u laboratorijama, nazalost.
Koristimo i neke prirodne preparate, pa ocekujemo da sledeci nalazi, pred VTO, budu bolji.
Srdacan pozdrav

Poštovana ...,

Dr. Kult je pregledao sve navedene podatke.
Što se tiče spermograma nema potrebe da se radi ponovo, pošto su nam podaci koje navodite sa starog spermograma potpuno dovoljni za VTO, naročito s obzirom da se oplodnja standardno radi putem ICSI. Dakle s te strane nema problema. Eventualno bismo Vam preporučili da se radi i PICSI (što je poboljšan izbor spermatozoida tj. test funkcionalnosti spermatozoida, tj. njihove sposobnosti da se vežu za omotač jajnih ćelija, ovo medjutim nije u ceni osnovnog ciklusa i plaća se dodatno, košta 300 evra).

Što se vas tiče i veoma smanjene vrednosti AMH hormona, sačekali bismo nove rezultate AMH testa, pa ako se potvrdi niska vrednost AMH, onda biste naravno ujedno trebala da razmišljate i o mogućnosti donacije jajnih ćelija gde imate daleko veće šanse.

Ipak pošto ste rel. mlada i nemate iza sebe nijedan pokušaj ček i ako je vrednost AMH niska, možemo pokušati VTO (još uvek ima smisla), ali su šanse kao što verovatno pretpostavljate znatno smanjene.

Što se protokola tiče Dr. Kult predlaže kratki agonistički protokol, naravno detalje i celokupan protokol bih Vam poslala čim budemo imali rezultat ponovnog testa i kada nam potvrdite da želite da počnete proceduru.

Inače doktor predlaže da se čujete skajpom (vreme i dan moramo dogovoriti unapred) da Vam još jednom lično obrazloži njegovo mišljenje.

Ako ima još nekih pitanja slobodno napišite.
Bićemo u kontaktu, čekam rezultate novog AMH testa.

Poštovanje,

Marija Ćulibrk
Koordinator IVF programa


Poštovana Marija, hvala vama i dr. Kultu na angažovanju i analizi naše situacije.
Što se tiče spermograma, on će se svakako ponoviti. ICSI je naš izbor, nismo ni protiv PICSI.
Ja verujem u tom smislu u dobar rezultat, pogotovo što su se ti isti spermatozoidi dobro pokazali pre 8 meseci, kao i moje jajne ćelije.
Ja smatram i osećam da je u mom slučaju jedini problem tubarni faktor.
Što se tiče AMH, ne kažem da je to nije jedna od smernica u analizi ovarijalne rezerve, kvaliteta, kao i eventualnog odgovora na stimulaciju. Međutim, moj argument je spontana trudnoća koju imam iza sebe, kao osnov da mi dokazano jesmo kompatibilni, da imamo rezerve i da možemo imati našu decu. Drugi argument je moj osećaj sopstvenog tela, ovulacija i kapaciteta, koji samo ja znam, kao što zna i oseća svaka žena. Dakle, apsolutno ne dolazi u obzir donacija, jer sam ja naprosto ubeđena u uspeh i sa puno pozitivne energije, a i znanja i informisanosti ulazim u sve ovo. Alternativa bi bila usvajanje, ili posvećivanje našoj deci koju već imamo u okviru uže porodice. Takođe, nisam spremna na besomučno iscrpljivanje, stimulacije, nadanja i razočaranja. Mi ćemo pokušati i dati sve od sebe. Ako ne uspe, tražićemo druge načine. O svemu ovome možemo pričati sa doktorom putem interneta. Kad budem imala gotove rezultate, ja ću vam ih proslediti. Puno pozdrava.

Poštovana ...,

U redu, razumem u potpunosti vaše argumente. I mi smatramo da biste trebala probati bar jednom VTO/ICSI+PICSi i pored niske vrednosti AMH, pošto ste mlada kvalitet jajnih ćelija bi još uvek trebao biti zadovoljavajući.

U svakom slučaju vredi pokušati.

Čekamo dakle novi AMH i instrukcije kada biste vi bili spermni za razgovor sa doktorom ako želite putem skajpa.

Srdačno,

Marija Ćulibrk



I tu smo završili priču...
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Počalji od neca73 taj 15/3/2013, 12:22



Što se vas tiče i veoma smanjene vrednosti AMH hormona, sačekali bismo nove rezultate AMH testa, pa ako se potvrdi niska vrednost AMH, onda biste naravno ujedno trebala da razmišljate i o mogućnosti donacije jajnih ćelija gde imate daleko veće šanse.


Inače doktor predlaže da se čujete skajpom (vreme i dan moramo dogovoriti unapred) da Vam još jednom lično obrazloži njegovo mišljenje.


I tu smo završili priču...[/quote]

Draga Erato, zahvaljujuci doticnoj Mariji Culibrk ja sam postala clan ovog foruma. Meni doduse nije ni predlozila da ponovim AMH. (samo zbog niske vrednosti istog, mi je rekla da razmisljam samo o donaciji jajne celije)

Podvukla sam slicne recenice koje sam dobila u prepisci sa njom. Da ne kazem da mi je donaciju jajne celije naturala 6 meseci nakon spontane trudnoce. Ne znam ko su oni, deluje mi da su specijalizovani za donaciju. Sa Dr Kultom sam odbila da razgovaram preko skajpa, a jos se tresem kad se setim Marijinih mejlova. Ne preporucujem ih nikome.
neca73
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Počalji od Erata taj 15/3/2013, 12:26

Neco, nije ona predložila da ponovim AMH, već ja Wink
Sačuvaj Bože!
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Počalji od Erata taj 15/3/2013, 12:27

Što je najgore oni te unapred pripremaju za neuspeh i kada se to desi, verovatno bi bili u fazonu - pa mi rekosmo donacija!
Erata
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Počalji od Erata taj 15/3/2013, 12:28

FERTIMED, Olomouc, Češka

Dear ...,

Thank you for contacting our fertility centre. Here is some more information that you may find useful.

We are specialists in all types of fertility treatment except surrogacy.

Treatment at our centre gives you access to a very high standard of knowledge (fully comparable with the USA and other European countries) coupled with a low cost for all medical procedures and drugs.

Our legislation allows us to be open to most types of medical procedure and fertility treatment:

Complete infertile couple examination (all in 7 days)

IVF- In Vitro Fertilization

AH – Assisted Hatching

ICSI – Intracytoplasmic Sperm Injection

TESE – Testicular Sperm extraction

MESA – Microsurgical epididymal Sperm Aspiration

PICSI

Embryo monitoring

Egg donation

Sperm donation

Cytoplasmatic Transfer – transfer of donor cytoplasma to recipient egg

PGD – Preimplantation Genetic Diagnosis

Embryofreezing

Blastocysttransfer


The best scenario is for you and your yokemate to come to our centre, bringing with you all relevant medical examination records. We can then study all your results and suggest the best possible course for the examination and procedure required to aid your fertility.

We can normally offer the first appointment within 2 weeks of contact.


Pricelist:

IVF-ICSI-AH-Blastocystcultivation-Anest. 2 100 Euro

IVF-ICSI-AH-Blast.-Anest.-Cytoplasmic transfer 2 300 Euro

IVF-ICSI-AH-Blastocystcultivation-Donor eggs 2 000 – 3800 Euro

IVF-ICSI-AH-Blastocystcultivation-Anest 2x-TESE 3 100 Euro

PGD IVF-ICSI-AH+2000-3000 Euro

Complete infertility couple examination package (+7 nights+2 consultations)3 500 Euro

HSK/UTHL+anest. 700 Euro

HSK+anest. 300 Euro

Medication: Puregon rekombinant FSH (2 250 IU)about 1 000 Euro

Fostimon 75 IU urinar FSH (2 250IU)about 500 Euro

Orgalutran (antagonist) 0,25 mg about 50 Euro

First consultation 200 Euro

Transport from Vienna (Prague, Bratislava) airport 250 Euro

Transport from Brno (Ostrava) airport 100 Euro

Accommodation 30 Euro/Prs./Night

Accommodation Apartment 80 Euro/Night

All payment is in cash.



You can find more information on our Web sites: www.fertimed.cz

Answers:

1. Please describe what would be the procedure for IVF treatment in your clinic – from consultations to the embryo transfer? After consultation you can choose date, place of stimulation (CZ or Serbia)

2. What method of IVF do you recommend for us? All procedures available. You can choose after discussio cheaper (IVF) or more expencieve (PICSI, embryo monitoring)

3. What is the complete price for the IVF treatment (including all necessary steps and all recommended procedures for our case, from the start to the end of embryo transfer), without medicines? We are also interested in embryo freezing. More detail on www.fertimed.cz

4. What protocol and medicines do you recommend for me? I need more medical information (hormons day 3, weight, smoking, US examination etc.) mostly we use long analog protocol and reccombinants, sometimes antagonists.

5. What is the maximum number of embryos transferred per one cycle? 2

6. Do you practice the permanent embryo monitoring with embryoscope? yes

7. What is the estimate date to begin the procedure, based on the attached information and your schedule and availability? Maybe November 2012?

Expected beginning of my menstrual cycle is about 15th November. We can start from first period or later.

8. What is the success rate for “our case group” in your Clinic? ? I need more medical information (hormons day 3, weight, smoking, US examination etc.). You can study result list on www.fertimed.cz

9. Do you practice that one doctor leads patient from the beginning to the end of the treatment? We are on duty 7 days a week. Same examnation will be done by an other physition.

10. Do you recommend us to use some vitamins or herbal products prior to IVF treatment? Standart vegitable and friut is suficient.

11. Do you recommend any specific activities or anything which can improve our chances for success? Any physical aktivity is welcome.



You can book your first consultation appointment by phone.



I am looking forward to meeting you soon.

Sincerely.

Yours



Doc. MUDr. Ales Sobek, CSc.

FERTIMED

Boleslavova 2

Olomouc

Czech Republic

00420-585224128

Erata
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Počalji od neca73 taj 15/3/2013, 12:30

da, meni su sanse inace po njima za spontanu 1% (nije znala da sam spontano zatrudnela), za vto 5%, a donacija jc 50%.
uh, evo jos se ja oporavljam od soka. a to mi je bio prvi upit koji sam poslala.
neca73
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Počalji od neca73 taj 15/3/2013, 12:33

erato ::Neco, nije ona predložila da ponovim AMH, već ja Wink
Sačuvaj Bože!

Ja kad sam rekla da bih ga ponovila, rekla mi je da nema potrebe, to je to, 39 godina, sta sam pa ocekivala.
neca73
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Počalji od Erata taj 15/3/2013, 12:36

Meni su neviđeno digli pritisak. I ja se naježim kada se setim. Lako je sada čitati, ali onda... kada čovek ulazi u nepoznato i bira kliniku, jeza da te uhvati od njenog "tona".
Erata
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Počalji od neca73 taj 15/3/2013, 12:49

ja sam toliko plakala, da mi je muz obrisao sve njene mejlove sa kompa, i zabranio da sedam za isti. tako sam i usla u ovu pricu, i da znas da mi mnogo forum znaci, kad znam da nisam jedina i da je to preziveo jos neko, i da ne moze tek tako biti i istina. i to jos ti imas 33 godine, strasno.


neca73
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Počalji od Erata taj 15/3/2013, 12:53

Nisu oni jedini koji su mi predlagali donaciju.
Ima tu jos materijala. Postavicu sve sto imam od prepiski.
Ima svega u ovoj našoj priči. Malo je pravih i poštenih, a donacije im se više isplate i lakše im je da rade sa mladim i kvalitetnim jajnim ćelijama, nego da se zaista pomuče i pomognu. I ja sam bila u šoku. Izmakli su mi tlo pod nogama, a onda sam se sabrala, pa im odgovorila. Kao što vidiš, uporno su ponavljali da nemaju attach-ovan dokument sa svim informacijama i nalazima, jedini oni. Nije meni problem da pošaljem ponovo, ali površni su, ne gledaju i još se ljute.
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Počalji od Erata taj 22/3/2013, 13:10

Clinic of Reproductive Medicine and Gynecology Zlin, Češka

Dear ...,

Thank you for your mail. Our doctor looked at all the information you gave us and she is happy to go ahead with your treatment.

Please find more information attached. There is also First virtual visit form, most of this information you have send us already but could you read this form through and fill in any info we might not have yet, please? If we manage to get all the paperwork and all the information we need, there should be no problem in starting your treatment in November.

Just to anter your question, the normal prectice is on Doctor takes your case from the beginning till the embryotransfer.

We will be looking forvard to hearing from you soon.

Kind regards



Eva Valentova



The success rate of IVF in age group up to 35 years is around 45-50%, in age group of 35-40 years it is around 30-35% and over 40 years it is 5-20% the biochemical pregnancy (depends of hormonal levels of each client).
There is no waiting time for IVF treatment.
Before the treatment you have to take the BC pills for 1-2 months (but minimum 18 days) and withdraw the pills 4 days before your appointment at our clinic.

The hormonal stimulation starts on the 2nd or 3rd day of your period.
The short antagonist protocol for hormonal stimulation takes about 13-15 days. Egg retrieval is done under short general anaesthesia. The emryotransfer is ususally scheduled after 3-5 days embryo cultivation. The remaining embryos can be cryopreserved, if is possible. We usually transfer 2 (max. 3) embryos.
The overall time you should stay in Zlin is 21 days. Our doctors insist to undergo all visits during your treatment at our clinic. During hormonal stimulation is the risk of Ovarian hyperstimulation syndrome (OHSS) complication from the fertility medication.


Consultations and examinations
1. First consultation – start IVF stimulation on day 2(max.3) of your period (ultrasound, blood checking for hormonal analysis, and STD tests for both partners)

2. Second examination on day 6-7 of your period

3. Third examination approximately 10th day of period.

4. Egg retrieval is around day 12 - 14 of period

5. ET (embryo transfer) is around day 17-19 of period.( no limit for transfered embryos)



List of test (these tests must be done before you come to Zlin)

Male Partner
•Results of the sperm analysis if partner’s sperm is used and send me via email before your arrival for checking. Both partners
•Results of STD tests: HIV 1,HIV 2, Hepatitis B, Hepatitis C, and Syphilis (RRR,TPHA). The results of STD tests must not be older than 12 months. Please send the copy of them to me in advance. Please bring originals with you.

Please find attached a medical history form. Please fill it in and send back to me ASAP.
If you have any medical exams from other sources, please send it also by e-mail.
All your medical records will be passed to our doctors before your arrival to study.




IVF Treatment – Fee Schedule
IVF treatment 2200 €
Basic cost includes:
 Consultation
 Ultrasound
 Treatment protocol
 Monitoring of IVF cycle
 Oocyte retrieval + anaesthesia
 Fertilization up to 10 oocytes via ICSI
 Extended embryo cultivation
 Assisted hatching
 Embryo transfer
 Cryopreservation of surplus quality embryos and their storage for 1 year
 Partner´s semen analysis (+ semen freezing and storage for 1 year)
 Tests for presence of sexually transmited diseases : HIV 1+2, Hepatitis B +C, Syphilis
Basic cost doesn´t include:
 Stimulation drugs until pregnancy test
(Dosage for 1 cycle - depended on ovarian function)
- Gonal F Pen or Puregon Pen 1x900IU 400 € /per 1 box.......2-4x
- Cetrotide or Orgalutran 1x0,25mg 45 € /per 1 box……...5x
- Ovitrelle 250micrograms/0,5ml 20 € /per 1 box..........1x
- Prednison 5mg (20 tab) 2 € /per 1 box……...1x
- Anopyrin 20mg (20 tab) 1 € /per 1 box….…...1x
- Utrogestan 100mg (30 tab) 10 € /per 1 box……...4x
 Donor sperm 200 €
 Intralipid infusion 100 €
 Partner´s sperm retrieval via microsurgical procedure (MESA/TESE) 600 €
 ICSI over 10 oocytes – each additional oocyte 40 €
 PICSI – up to 10 oocytes 180 €
 PICSI – each additional oocyte ( over 10) 50 €
 Frozen embryo transfer ( FET ) 500 €
 Pre-implantation genetic diagnosis (PGD) individual price
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Počalji od Erata taj 22/3/2013, 13:27

ROYAL MEDICAL, agencija, Češka

Dear ...,

Thank you for your email. My name is Martina and I will be your coordinator in the process of preparation and arranging the treatment in the Czech Republic. Please do not hesitate to ask me questions. I respond to emails on a daily basis, or if you wish you can call me on +420 224 091 388. We exist because all patients appreciate a well-informed source of information with whom to consult all areas including, safety, different methods and treatment costs.

As you have asked about infertility treatment, we researched many clinics and hospitals in the Czech Republic. We are able to offer you this treatment in two different Clinics, both have excellent results in IVF. Success rate is quite high and above the average. In addition, these clinics are very popular abroad, and we are more than satisfied with the high quality medical care they provide. Due to low AMH we recommend you to have the IVF treatment with egg donation.

Option A. Clinic in Prague is a favorite IVF Centre with experienced specialists. The gravidity was achieved in 42% under the age 35 and in 37% over age 35. We can arrange suitable accommodation with a fair price and also close to the clinic.

Price
CZK 143,670 (at the current exchange rate this is € 5,817 for all IVF + oocytes donation program)

Staying
8 days

Waiting time
2-3 months

TRANSPORT FROM THE PRAGUE AIRPORT FOR FREE

Personal assistant will wait for you at the airport and take you by car to your hotel for FREE

Option B. Clinic in town ZLIN – a pleasant city in the eastern Bohemia

This clinic is popular for its good results in IVF treatment: The present success rate of the fresh egg donation to date amounts to the following 65% for the biochemical (positive hcg) and 50% for the clinical (heartbeat) pregnancy. We usually arrange the transport from the Prague´s Ruzyně airport to Zlin (300km from Prague = 3 hours) or from the airport Brno – Turany (app 1 hour) for our clients.

Price
€ 4,500 (not incl. pharmaceuticals + app € 1,000 for IVF + oocytes donation)

Staying
8 days in Zlín

Waiting time
no waiting time for donated oocyte thanks to a sufficient number of donors

Please let us know in which clinic you are interested. After choosing one of clinics we will answer the rest of your questions.

The preparation for IVF takes 5-6 weeks. You can plan the treatment for November this year.
Our services include pre-departure consultation and on-site service. We care for the full comfort of clients. To ensure all of your requirements are met, please complete the form which can be found at the following web link: Application form
At this point, we will pass your data to the Chief Doctor and will send you more detailed information regarding the entire schedule.

Please feel free to contact us for any further information.

Best regards,

Martina, RM Assistant
Royal Medical, Prague
www.royalmedical.cz
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Počalji od Erata taj 22/3/2013, 13:29

Dear Martina,
I have missing call from you today. Sorry, I have not be able to answer. We have received your offer for the egg donation programme. But, we are not interested in egg donation. AMH is not only index for ovarian reserve. I do not believe in AMH. I had one natural pregnancy before 8 months. Unfortunatelly, because of tubal factor, it was an ectopic pregnancy. Also, I have ovulations proved by foliculometry. At the end, I believe in my own eggs. I am woman and I have sense and feeling for my whole body, including ovarian function. And I will have my own children. Thank you again.
Best regards.

Dear ...,

thank you for your email. Of course we are able to assure you the IVF treatment using your own eggs. Doctor proposed the egg donation due to your medical history but we are ready to meet your wish.

Here is the information about IVF using own eggs:

· Clinics

A. Clinic in Prague is a very popular IVF Centre with experienced specialists. We can arrange suitable accommodation close to the clinic.

Price: 93,400 CZK ( € 3,736 due to the today´s exchange rate) incl. pharmaceuticals

TRANSPORT FROM THE PRAGUE AIRPORT FOR FREE

Personal assistant will wait for you at the airport and take you by car to your hotel for FREE

B. Clinic in town ZLIN – a pleasant city in the eastern Bohemia. The clinic is popular for its good results in IVF treatment. We usually arrange the transport from the Brno – Turany airport to Zlin (70 km from Prague = 1 hour) for our client.

Price: € 2,200 (not incl. pharmaceuticals = app. + € 1,000)

· Length of stay

A) Complete IVF cycle at our clinic.
Time requirements – arrival in Prague directly before menstruation, the patient resides for approx. 3 weeks. In addition, residence of your partner may be minimized to 2-3 days.

B) IVF cycle in coordination with your gynaecologist at your residence (only clinic in Prague).
Time requirements – this alternative requires two visits in Prague, the first may be managed in a single day. Subsequently, in an arbitrary further cycle, the stimulation treatment itself with check-ups by a coordinating gynaecologist. The arrival is required 2 days prior to ova (egg) extraction, and the patient leaves approx. 7-9 days afterwards. The partner may leave after 2 days.

Please let us know in which clinic you are interested.

After choosing one of clinics we are able to explain you all process and let you know the details.

I hope to hear from you soon.

Best regards
Martina, RM Assistant
Royal Medical, Prague


Dear ...,

have you received our email concerning the IVF treatment in the clinics in the Czech Republic? Are you still interested? Do not hesitate to contact me with any futher questions.

Best regards,

Martina, RM Assistant
Royal Medical, Prague



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Počalji od Erata taj 22/3/2013, 13:32

REPROFIT International, Brno, Češka

Dear Mrs. ...,

thank you for your interest to become our patient, thank you for your medical history.

My name is Světlana Mejtilová and I am responsible for the treatment of
foreign patients at Reprofit International, Clinic of Reproductive Medicine.

Here you are the information about IVF treatment, also in the attachment.

The price for IVF is 1 950 Euro. The drogs for IVF cycle cost about 1 500-2 000 Euro, it depends on amount of Medicaments.

There is no waiting time for IVF with your own eggs.

In the attachment I am sending you the questionnaire „first virtual visit“ and personal dates, which I would like to please you to fill out and send it back to me.

Thank you

Best regards
Světlana Mejtilová
IVF coordinator
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Počalji od Erata taj 22/3/2013, 13:33

In vitro fertilization (IVF) instructions
In vitro fertilization as a part of assisted reproduction techniques helps to treat infertile couples with great success.

Reasons for IVF include
a) Abnormal semen analysis (low count, impaired motility or morphology)
b) Immunological reasons (endometriosis, sperm antibodies)
c) Damage to fallopian tubes
d) Ovarian dysfunction (anovulation)
e) Unexplained infertility

In vitro fertilization includes medical and laboratory procedures - handling of human sperm and human eggs. After hormonal stimulation (hormonal injections) that enables the development of larger amount of human eggs (oocytes), these eggs are collected transvaginally under a general anaesthesia (oocyte retrieval). Sperm is added to the media with collected eggs and these eggs are fertilized.
After fertilization, gained embryos are cultivated outside of the woman’s body for at least 48 hours and consequently placed inside the patient’s uterus (embryotransfer).

Ovarian stimulation monitoring
Every patient undergoing a hormonal stimulation takes hormonal drugs and follows a personal stimulating protocol created by their treating doctor. When the follicles reach the diameter of 18-20 mm they should contain mature eggs and a final injection inducing ovulation is applied. Oocyte retrieval is scheduled 36-38 hours later.
Male partner has to provide a sperm sample on the day of oocyte retrieval unless sperm from an anonymous donor is used.

Intracytoplasmatic sperm injection (ICSI) is used when the sperm samples show low quality. Single sperm is gently injected directly into the oocyte by a micropipette. This procedure is done by an embryologist. Success rate of egg fertilization is around 80-90%.

Cultivation longer than 48 hours enables to „select“ the best embryos for transfer. We are able to cultivate embryos for up to 5 days after the oocyte retrieval. Extended cultivation increases the success rate.

Assisted hatching helps embryos to implant. Embryo cover (zona pellucida) is gently opened just before the embryotransfer. Female patients over the age of 35 or patients with repeated implantation failure can benefit from this procedure.

Embryotransfer
Very easy and delicate procedure when embryos are placed inside the uterus. This procedure is similar to a routine gynaecological exam in specula. It is a painless procedure. Both partners decide on the number of embryos transferred. Consultation with an embryologist and a doctor is advised.

Urine pregnancy test can be done 14 days after the embryotransfer.

Pregnancy, as a result of a successful treatment, is not affected by IVF procedures. Chances of a successful pregnancy are the same as a pregnancy after a natural conception. After a pregnancy is confirmed, there are still possibilities of a miscarriage or an ectopic pregnancy.

Complications associated with an IVF treatment
There may be no response to the ovarian stimulation or oocyte retrieval reveals low quality oocytes, male partner provides no sperm or fertilization fails. Cultivating embryos can also stop developing. Under these conditions the cycle is cancelled without embryotransfer.

There can be some complications from ovarian stimulation but they are rare.


A – Ovarian stimulation complications

1. Ovarian hyperstimulation syndrome (OHSS)
Is caused by an abnormal reaction of the ovaries to the hormonal stimulation. The cause of such reaction is not known, but certainly there is an ovarian malfunction. Patients suffer from abdominal pain, enlargement of ovaries and also liquid is collected in the abdominal cavity. Mild and moderate syndrome (95%) can be treated easily and only need to be observed. Patients with severe form of OHSS have to be hospitalized for a week. The most severe cases have to be treated at the intensive care unit.

If there are signs of an excessive reaction during a stimulation, termination of the cycle is advised. OHSS after oocyte retrieval should not be followed by embryotransfer and embryo freezing is proposed.


3. Abdominal pain
Slight abdominal pain can develop during stimulation and has no consequences. Once the pain starts getting worse, ovarian hyperstimulation must be excluded.

B – Complications during oocyte retrieval

1. Complication after general anaesthesia
Please inform the anaesthesiologist about all of your health issues as he/she is responsible for your general anaesthesia.

2. Abdominal cavity bleeding
During the ultrasound-guided oocyte retrieval, injury to the blood vessels, bowel or other organs can occur. It is very rare but it can not be completely excluded. Patients must be immediately taken to the hospital.

C – Complication during embryotransfer

Slight abdominal pain and discomfort can be observed after embryotransfer. Also a very mild vaginal bleeding (spotting) from the cervix can occur.

D – Complications after embryotransfer

Mainly pain and enlargement of abdomen are suspicious by a late onset of an ovarian hyperstimulation syndrome. Please contact the doctor at our clinic



Our hot line is available 24 hours to all patients with any possible complications. Please call anytime:

+ 420 774 11 77 66

Our experienced nurse can help you get your issue resolved, offer you advice or forward the call to the doctor in charge.
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Počalji od Erata taj 22/3/2013, 13:39

IAKENTRO, Atina, Grčka

Dear Mrs ... and Mr ...,

After your request for a medical opinion after careful examination of your medical history from Professor Prapas, we will try to reply to all your answers the best possible:

1. Please describe what would be the procedure for IVF treatment in your clinic – from consultations to the embryo transfer?

According to Professor Prapas, the best thing to do is to come by our clinic for an eventual consultation with him so as explain to you the IVF treatment which could be adapted to your needs and give you the protocol that you must follow.

2. What method of IVF do you recommend for us?

After a look to your AMH, we can see that it is kind of low and thus we can not recommend an IVF method as several things depend on your AMH

3. What is the complete price for the IVF treatment (including all necessary steps and all recommended procedures for our case, from the start to the end of embryo transfer), without medicines? We are also interested in embryo freezing.

The price is between 2500-3000€ (cryopreservation including) without the treatment.

4. What protocol and medicines do you recommend for me? Again this must be decided after a personal consultation in our clinic.

5. What is the maximum number of embryos transferred per one cycle? The max number of embryos that we can transfer according to the Greek legislation is 3.

6. Do you practice the permanent embryo monitoring with embryoscope? NO

7. What is the estimate date to begin the procedure, based on the attached information and your schedule and availability? Maybe November 2012? It would be possible for November but again we do propose first a consultation.

8. What is the success rate for “our case group” in your Clinic? In the age- case group that you belong, the success rate is around 45-50% but still your AMH may influence the final result

9. Do you practice that one doctor leads patient from the beginning to the end of the treatment? Yes

10. Do you recommend us to use some vitamins or herbal products prior to IVF treatment? No

11. Do you recommend any specific activities or anything which can improve our chances for success? No

We are staying at your disposal for further clarifications or information.

Best regards,

Vasso Tsaknaki
IVF Coordinator-Assistant
Tel: 0030 2310 330519
Fax:0030 2310 325765
E-mail: infofr@iakentro.gr

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Počalji od Erata taj 22/3/2013, 13:44

REPROGENESIS, Brno, Češka

Dear ... and ...,

Thank you very much for making a contact with our clinic. If you are decided for IVF treatment with your own eggs, I will gladly help you.

Also thank you for all information about you attached. It is good for us to get to know your case from the beginning including all necessary information. However before your treatment we will need to have done from both of you test for infectious diseases (Hepatitis A, Hepatitis B, Syphilis, HIV 1, HIV 2). None of them should be older than 3 months. We will also need a new sperm analysis from your partner and your hormonal status (TSH, PRL, E2, LH, FSH) on the day 2 or 3 of your cycle.

Now let me try to answer all of your questions.

1. Please describe what would be the procedure for IVF treatment in your clinic – from consultations to the embryo transfer?

If you are interested about, is possible to come for an Initial consultation with our doctor specialist. During this meeting you will receive detailed information about the most suitable treatment to fit your needs. These consultations are done every day between Monday to Friday, from 10:00 till 14:00 o´clock. The price of consultation is 100 Euro and includes also ultrasound examination of your uterus and ovaries. Let me know, if you are interested in and I´ll be happy to arrange you an appointment. However, it is not necessary for you to come to Brno for this consultation if it is not convenient for you; everything can be discussed via email or phone and all the tests preceding the transfer can be conducted by your regular doctor.

We will plan treatment with regards on your time schedule. Entire treatment takes approximately 7 or 8 weeks, depends on type of treatment. You will start a preparation cycle with common hormonal monophasic contraception. On the day 2 or 3 of your cycle have to be done LH, FSH, E2, TSH and PRL tests. We recommend come into the Czech Republic from 1st ultrasound scan of follicle sizes and stay to the embryotransfer. Totally it is approximately 14 days, during which are done 2 u/s scan, eggs retrieval and embryotransfer (could be +or- 2 days).

2. What method of IVF do you recommend for us?

It is based on the result of your partner´s sperm analysis. However a standard and recommended process is with ICSI since the fertilization of embryos is distinctly higher with using ICSI method and success is increased. We always prefer embryo transfer on the day 5 of cultivation at their blastocyst stage. On the 5th day there is a higher success of selection the best embryos.

3. What is the complete price for the IVF treatment (including all necessary steps and all recommended procedures for our case, from the start to the end of embryo transfer), without medicines? We are also interested in embryo freezing.

The price of ICSI cycle with own eggs is 2000 Euro and includes treatment protocol, monitoring of your IVF cycle, oocyte retrieval, fertilization of all mature oocytes via ICSI, Prolonged embryo cultivation, Assisted hatching and embryo transfer. There is also fee of approximately 1500 Euro for your treatment medications, exact price depends on your current level of blood hormones.

Cryopreservation of embryos and their storage for 1 year costs 300 Euro.
I can also recommend you further method of assisted reproduction-Monitoring of embryos, which allows embryologist watch continuously development of embryos without necessity to taking them out of the cultivation box and exclude embryos with abnormal development. At the day of embryotransfer treated woman get DVD with record of transferred embryos. This method can increase chance for pregnancy by more than 10% and risk of miscarriage is with using this method less than 6%. We recommend this method for women, which have more previous unsuccessful treatment for increasing chance to choice of the best quality embryos for transfer. The price of this method is 500 Euro. You can take a look at the following link, where you can see how Monitoring of embryos looks like: http://www.fertilitech.com/Default.aspx?ID=44

4. What protocol and medicines do you recommend for me?

Unfortunately I am not able to tell you right now what protocol and medications will be recommended for you. It is based on your hormonal status. After that we will be able to set your treatment plan including all medication and their usage.

5. What is the maximum number of embryos transferred per one cycle?

The maximum number of embryos for transfer is 3. However it is not recommended at all for the first IVF cycle. Since there are risks following from multiple pregnancy in accordance to transfer of 3 embryos e.g. (premature delivery, immature foetus, immature organs, higher risk of infections). We standard recommend just 2 of them.

6. What is the estimate date to begin the procedure, based on the attached information and your schedule and availability? Maybe November 2012?Expected beginning of my menstrual cycle is about 15th November.

We have no waiting time for the treatment. So you can start as soon as you want, November 2012 is definitely ok .

7. What is the success rate for “our case group” in your Clinic?

Our success rate from ICSI cycle with own eggs is 60% of clinical gravidity in age group of women up to the 40 years.

8. Do you practice that one doctor leads patient from the beginning to the end of the treatment?

Yes, absolutely.

9. Do you recommend us to use some vitamins or herbal products prior to IVF treatment?

We recommend using a folic Acid and vitamin B6, ideally to start using 2-3 months in advance. So you can start to take it right away.

10. Do you recommend any specific activities or anything which can improve our chances for success?

Here I can recommend you a possibility of having done acupuncture before and after the transfer at our clinic. This method is very beneficial for muscles relaxation, better blood flow of the uterus and also stress decreasing. However the most important advice from us is to be in good mood and relaxed.

If you have any more questions, please do not hesitate to ask me anytime, I will glad to help you.

Have a lovely day and I´m looking forward to your response.

Kind Regards

Helena
Ing. Helena Ambrožová
IVF coordinator



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