Saline infusion sonography (SIS) or sonohysterography entails saline injection into the uterine cavity under ultrasound guidance. The sensitivity of sonohysterography is significantly better than that of a transvaginal ultrasound with regards to all kinds of intrauterine pathology such as polyps and fibroids. It also acts as a mock embryo transfer, giving us valuable information regarding the ease of accessing the uterine cavity.
A saline infusion sonography (or aquascan) is done at our clinic, usually during your first consultation with us. You can have an aquascan after your period has finished but before ovulation. Depending on the findings you may be referred to have a hysteroscopy or laparoscopy.
The role of the immune system in terms of implantation failure and recurrent miscarriages, has received much attention by the scientific community in recent years. The immune system plays a key role in reproductive medicine. It helps our body to distinguish self from non-self and protects us against infections and abnormal or malignant cells. Complex interactions between the developing trophoblast of the future embryo and the endometrium occur which lead finally to a state of maternal-fetal tolerance. Derangements of the immune system can prevent implantation or cause a miscarriage.
A comprehensive panel of tests is currently available that tests different components of the immune system. At Serum, we provide immune testing to patients when this is indicated by their medical and fertility history.
HLA-DQ Alpha Testing:
This test determines if partners share tissue proteins that are too similar (tissue-type compatibility). If compatibility is high, the female will not produce blocking antibodies that protect the fetus from an immune attack and so the fetus is prone to rejection.
Leukocyte Antibody Detection (LAD)
This test measures the level of blocking antibodies in a woman’s blood. If the level of such antibodies is low, there is higher possibility that the fetus will be rejected.
Reproductive Immunophenotype (RIP)
Lymphocyte is a type of white blood cell (WBC) and it is the major cell of the immune system. There is a large variety of lymphocytes, and each type expresses different protein molecules on their cell-surface. These cell-surface molecules are markers which allow us to identify the different types of lymphocytes in the lab. The proportion of the various lymphocyte types is very important and some disturbance in this matter may denote an immunologic problem.
Natural Killer Cell Assay
NK cells are lymphocytes which mediate cell destruction (cytolysis), produce cytokines and mediate natural resistance against tumor cells. With the NK cell assay we separate the NK cells from the woman’s blood and mix them with target cells. In other words we test the ability of the NK cells to kill.
Blood Clotting Defects
These are conditions which lead to a hypercoagulable state and are associated with blood clots in the very small arteries and blood vessels. The specific tests are:
Antiphospholipid antibodies (Lupus anticoagulant, antibodies against cardiolipin etc)
Inherited Thrombophilias (Factor V Leiden gene mutation, protein C & S deficiency, MTHFR 677 T mutation etc)
Spontaneous abortion or miscarriage is defined as the non-induced loss of a pregnancy before 20 weeks of gestation. Overall, 50-75% of miscarriages are due to sporadic chromosomal abnormalities and hence occur by chance. The most common ones are trisomy’s such as Down’s syndrome (Trisomy 21). Maternal ageing is associated with an increased risk of miscarriage, which reflects a rising prevalence of oocyte aneuploidy. Karyotype of both partners or of the abortus can provide evidence towards the type of anomaly or may suggest a non-genetic cause when normal. IVF with pre-implantation genetic diagnosis (PGD) and selected transfer of euploid embryos is an established treatment for couples when one partner is a carrier of chromosomal anomaly.
Anatomic anomalies of the uterus predispose to an increased risk of pregnancy loss and can be identified by sonohysterography or the traditional hysterosalpingogram (HSG). The septate uterus is the most common anomaly and the one most closely associated with recurrent pregnancy loss. This malformation can easily be corrected via hysteroscopy. Cervical cerclage may help improve pregnancy outcomes in cases that exhibit progressive cervical shortening during pregnancy. Uterine leiomyomas/fibroids especially those that protrude into or displace the uterine cavity can be associated with pregnancy loss.
Pregnancy outcomes are much improved after hysteroscopic removal of intrauterine adhesions. At Serum, we have pioneered the performance of “implantation cuts” at the fundus of the uterus which has resulted in a significant increase in implantation rates. CLICK HERE
Maternal immune recognition and response play an important role in normal pregnancy and may be a cause of otherwise unexplained recurrent pregnancy loss. There is a lot of ongoing research in this area in the recent years and Serum offers an extensive testing and treatment for immune issues to its patients. CLICK HERE
Inherited and acquired thrombophilias resulting from mutations in clotting factors have emerged as a potentially important cause of recurrent pregnancy loss. Pathologic thrombosis results from an imbalance between coagulation and fibrinolysis. At Serum, we screen women for inherited thromobophilias who have an otherwise unexplained recurrent pregnancy loss or have a previous history of pregnancy complications that have resulted from thrombosis or failure of the placenta (such as preeclampsia and intrauterine growth restriction).
Endocrine factors are another cause of recurrent pregnancy loss. Thyroid disorders are easy to identify and treat and can be diagnosed by measurement of TSH. Evaluation of blood glucose and glycosylated hemoglobin is indicated for women with known or suspected diabetes. The risk of miscarriage is increased among women with polycystic ovary syndrome and may be significantly reduced by treatment with metformin.
Chronic infections of the reproductive tract are an important factor for infertility and pregnancy loss. At Serum, we perform PCR testing of period blood tissue in collaboration with two specialized laboratories in Athens. This test has very high sensitivity for diagnosing chronic infections (sub-clinical) such as Chlamydia, Ureaplasma or Mycoplasma. If an infection is identified, we pre-treat our patients with an antibiotic course before an intended IVF treatment cycle or even prior to a natural conception attempt.
Gynecological ultrasonography refers to the application of medical ultrasonography to the female pelvis (with focus to the uterus, ovaries, adnexae, bladder and the Pouch of Douglas). The examination can be performed trans- abdominally, (with a full bladder which acts as an acoustic window to achieve better visualization) or trans-vaginally. Trans-vaginal imaging gives better resolution of the pelvic organs, whereas larger lesions reaching into the abdomen are better seen trans- abdominally. Ultrasound is an invaluable tool in everyday practice as it is used to diagnose gynecologic problems such as uterine polyps, fibroids, adenomyosis, ovarian cysts and adnexal masses, including ectopic pregnancies. It is routinely used to follow up a natural menstrual cycle and can provide evidence for ovulation.
Specifically in IVF treatment protocols, the ultrasound scan gives valuable information such as the antral follicle count (AFC) as well as monitoring the response of the ovaries to controlled ovarian stimulation in women that undergo IVF (own egg programs). In donor egg cycles, the ultrasound is used to evaluate the response of the endometrium (internal lining of the uterus) to exogenous estrogens.
A basic laboratory workup is an essential initial part in the evaluation of infertility and offers valuable information. The results of these tests provide clues as to the etiology of the infertility problem and function as a guide to the next steps in management.
FSH along with LH (the so called gonadotropins) are hormones produced by the pituitary gland. They regulate the secretion of the ovarian hormones such as estradiol. FSH measured on menstrual cycle (day 3) is most commonly used to evaluate the ovarian reserve.
They are important hormones of the female reproductive system with a wide range of effects on many organs in the body. Estrogens facilitate growth of the ovarian follicles and they have an important role in the cyclic changes of the endometrium, cervix and vagina. 98% of the body’s estrogens are derived from the ovary. Estradiol level is commonly checked on day 3 of menstrual cycle (along with FSH) to evaluate ovarian function.
Anti-mullerian hormone (AMH)
AMH is produced by the very small (non selected) follicles of the ovaries. A serum AMH assay can be used to identify patients with low ovarian reserve and polycystic ovarian syndrome. It can also be utilized to screen patients considered high risk for hyperstimulation.
TSH & Prolactin
TSH is an important indicator of thyroid function. Since thyroid dysfunction and hyper-prolactinaemia are associated with menstrual irregularities and infertility, a serum TSH and prolactin level should always be checked and corrected prior to instituting therapy.
Pre-screening for Infections
According to the Greek Law we have to obtain a panel of blood tests for infectious diseases before any IVF treatment. These include test results for hepatitis B, hepatitis C, HIV type I-II and syphilis.
A variety of blood tests for immune issues are available. For more information CLICK HERE
Hysteroscopy is the gold standard for diagnosing and treating intrauterine pathology which may adversely affect fertility.
Developmental anomalies of the uterus, such as a septum of uterus. Hysteroscopic septum resection can usually be performed as a relatively straightforward and quick procedure.
Hysteroscopy is the method of choice for treatment of intrauterine adhesions and is both safe and effective when performed by expert gynaecological surgeons.
Endometrial polyps are almost always benign endometrial growths that protrude into the uterine cavity. Polyps may interfere with implantation, cause local inflammation or distortion of the uterine cavity. They can be easily removed via hysteroscopy (hysteroscopic polypectomy).
At Serum, we have pioneered a procedure called hysteroscopy with implantation cuts During a routine hysteroscopy, the doctor uses the operative scissors to perform small cuts at the bottom of the uterus (fundus) along a line which extends between the entrances of the tubes on each side. The depth of the cuts extends down to healthy tissue. The fundus of the uterus is the implantation site of the embryo and by doing this technique we increase the probability for the embryo to implant.
Laparoscopy and dye test is the gold standard for the evaluation of tubal factor infertility. Injection of a dilute dye through a cannula attached to the cervix during laparoscopy, permits evaluation of the patency of the tubes.
On top that Laparoscopy provides a panoramic view of the pelvis and hence it can identify pathology such as adhesions or endometriosis that can adversely affect fertility. Most importantly, laparoscopy offers the opportunity to “see and treat” a wide range of pathology such as adhesions, ovarian cysts, hydrosalpinges, endometriotic lesions and fibroids.