Saline infusion sonography (SIS) or sonohysterography entails saline injection into the uterine cavity under ultrasound guidance. The sensitivity of sonohysterography is significantly better than transvaginal ultrasound with regards to all kinds of intrauterine pathology such as polyps and myomas. It also acts as a mock embryo transfer, giving us information on 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 an effort to explain and clarify implantation failure and recurrent miscarriages, has received much attention by the scientific community in the recent years. The immune system is the key that determines the existence of an organism. 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 conception and may lead to failed 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 involuntary termination of pregnancy before 20 weeks of gestation or below a fetal weight of 500g. Overall, 50-75% of miscarriages result from numerical chromosomal abnormalities and occur by chance. The most common are trisomies. Maternal ageing is associated with an increased risk of miscarriage, which reflects a rising prevalence of oocyte aneuploidy. Karyotype of both partners or the abortus can provide evidence as to the type of anomaly or may suggest a non-genetic cause when normal. IVF with preimplantation genetic diagnosis 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 bleeding in collaboration with two highly technological laboratories in Athens, which offers the highest sensitivity for diagnosing chronic infections such as Chlamydia, Ureaplasma and Mycoplasma. In the case of a diagnosed infection, we pretreat our patients with an antibiotic course before an intended IVF treatment cycle or for trying to conceive naturally.
Gynecologic ultrasonography or gynecologic sonography refers to the application of medical ultrasonography to the female pelvic organs (specifically the uterus, the ovaries, and fallopian tubes) as well as the bladder, the adnexa and the Pouch of Douglas. The examination can be performed transabdominally, (with a full bladder which acts as an acoustic window to achieve better visualization) or transvaginally with a specifically designed vaginal transducer. Transvaginal imaging gives better resolution of the ovaries, uterus and endometrium but is limited to depth of image penetration, whereas larger lesions reaching into the abdomen are better seen transabdominally.
Ultrasound is an invaluable tool in everyday gynecological 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 as the antral follicle count (AFC) and in monitoring the response of the ovaries to hormonal stimulation in women that undergo treatment with their own eggs. 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 act in concert to regulate 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 with a variety of effects on many systems in our body. Estrogens facilitate growth of the ovarian follicles and they have an important role in the cyclic changes of the endometrium, cervix and vagina. Almost all of the estrogen comes 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 decreasing ovarian reserves and polycystic ovarian failure.
TSH & Prolactin
TSH is an important indicator of thyroid function. Since thyroid dysfunction and hyperprolactinemia is 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 most essential method for diagnosing and treating intrauterine pathology which may adversely affect fertility. Examples include:
Developmental anomalies of the uterus, such as septum of uterus. Hysteroscopic septum resection can usually be performed relatively straightforward as a brief procedure.
Hysteroscopy is the method of choice for treatment of intrauterine adhesions and is both safer and more effective than blind curettage.
Endometrial polyps are hyperplastic endometrial growths that extend into the uterine cavity. Polyps may interfere with implantation, cause local inflammation or distortion of the uterine cavity. Polyps can be easily removed via hysteroscopy (hysteroscopic polypectomy).
At Serum, we are pioneers in the performance of the “implantation cuts” at the fundus of the uterus. During a routine hysteroscopy, the doctor uses the operative scissors to perform cutting points at the bottom of the uterus along a line which extends between the entrances of the tubes on each side. The depth of the cutting is up to the emergence of 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 is considered generally as the definitive test for the evaluation of tubal factors. Injection of a dilute dye through a cannula attached to the cervix during laparoscopy, permits evaluation of the patency of the tubes.
Laparoscopy provides a panoramic view of the pelvis. Consequently, it can identify pelvic pathology such as adhesions and endometriosis that adversely affect fertility. Most importantly, laparoscopy offers the opportunity to treat disease such as destruction of adhesions, excision or ablation of endomteriotic implants and removal of fibroids.