The A-Z of fertility treatment

Alcohol has a negative influence on the fertility of women and men. The time until pregnancy occurs is significantly prolonged and the risk of miscarriage increases greatly. It is also important for men to limit alcohol consumption, as it can significantly reduce the quality and number of sperm cells. This already has an effect with a consumption of one or more alcoholic drinks per day or seven alcoholic drinks per week.

It has been shown that alcohol, even in small amounts, can lead to a disturbance of the child's development and to pregnancy complications. We therefore advise you to avoid alcohol during fertility treatment, pregnancy and breastfeeding.

During egg collection (= ovum pick-up) in the context of IVF, the follicles are aspirated with the help of a needle. It is necessary to puncture through the vaginal wall under ultrasound vision. Although the needle is as thin as possible, the procedure can still be painful.

Many patients ask for a local anaesthetic, which unfortunately is not possible for this procedure. But we can still offer you two different very effective options for pain relief or elimination for the follicle puncture:

• Sedation/caedema: Here we inject the drug "Dormicum" into your vein. It contains the active ingredient midazolam, which belongs to the group of so-called "benzodiazepines" and is thus closely related to the very well-known drug "Valium". Many patients really do fall asleep, some experience a twilight state. Some patients feel a little of the egg cell retrieval.
• Short anaesthetic: Our anaesthetic team will usually inject a mixture of a strong painkiller and propofol into your vein. This will always put you into a sleep-like narcotic state, during which it is sometimes necessary to help you breathe with a face mask. However, this form of short anaesthesia cannot be compared to a "general anaesthesia", in which a breathing cannula is usually inserted into the windpipe (=intubation) to constantly support the patient's breathing.

Both the sedation and the anaesthesia only last a few minutes, so you will wake up again immediately after the procedure. You will then stay in the relaxation room for about an hour for further observation. Your condition is monitored during the procedure and afterwards with a small sensor on your fingertip. Here we can see your heart rate and how much oxygen is in your blood.

Important: Please inform us of any symptoms, underlying diseases, previous findings, intolerances or allergies, etc. that are relevant to these forms of analgesia. If you have already had a sedation or anaesthesia and experienced nausea or vomiting afterwards, please let us know: Let us know this too, we can then prevent it with medication.

During egg collection (= ovum pick-up) in the context of IVF, the follicles are aspirated with the help of a needle. It is necessary to puncture through the vaginal wall under ultrasound vision. Although the needle is as thin as possible, the procedure can still be painful.

Many patients ask for a local anaesthetic, which unfortunately is not possible for this procedure. But we can still offer you two different very effective options for pain relief or elimination for the follicle puncture:

• Sedation/caedema: Here we inject the drug "Dormicum" into your vein. It contains the active ingredient midazolam, which belongs to the group of so-called "benzodiazepines" and is thus closely related to the very well-known drug "Valium". Many patients really do fall asleep, some experience a twilight state. Some patients feel a little of the egg cell retrieval.
• Short anaesthetic: Our anaesthetic team will usually inject a mixture of a strong painkiller and propofol into your vein. This will always put you into a sleep-like narcotic state, during which it is sometimes necessary to help you breathe with a face mask. However, this form of short anaesthesia cannot be compared to a "general anaesthesia", in which a breathing cannula is usually inserted into the windpipe (=intubation) to constantly support the patient's breathing.

Both the sedation and the anaesthesia only last a few minutes, so you will wake up again immediately after the procedure. You will then stay in the relaxation room for about an hour for further observation. Your condition is monitored during the procedure and afterwards with a small sensor on your fingertip. Here we can see your heart rate and how much oxygen is in your blood.

Important: Please inform us of any symptoms, underlying diseases, previous findings, intolerances or allergies, etc. that are relevant to these forms of analgesia. If you have already had a sedation or anaesthesia and experienced nausea or vomiting afterwards, please let us know: Let us know this too, we can then prevent it with medication.

Anti-Müllerian hormone (AMH) is produced in the granulosa cells. It is mainly produced by the early stages of the follicles (egg follicles) that have not yet been consumed. Therefore, a determination of this hormone is suitable for assessing the "ovarian reserve". The hormone can be determined independently of the day of the cycle.

The number of egg cells is already determined at birth and decreases in the course of life. The level of anti-Müllerian hormone corresponds to the amount of follicles still present and therefore also decreases with the years.

Limit value: If the AMH value falls below 1 ng/ml (corresponds to 7pmol/l), one speaks of a reduced oocyte reserve or restricted ovarian reserve.

Antibodies can be present in the cervical mucus which are directed against the sperm cells and make them immotile. This can be an obstacle for the sperm cells on their way to the egg.

The Kremer test can be used to find out whether these antibodies are present. A prerequisite for carrying out the Kremer test is a normal condition of the cervical mucus and a spermiogram with good motility and concentration of the sperm cells.

The antral follicles are egg follicles that mature in the ovaries at the beginning of the menstrual cycle. During this time, they can be detected, measured and counted in the ovaries using ultrasound. This ultrasound examination is called the antral follicle count (AFC). The follicles are two to eight millimetres in size.

0 to 7: If there are only a maximum of seven antral follicles on both ovaries together, this is an indication of severely reduced fertility.
8 to 11: The first signs of limited ovarian reserve are visible. 
12 to 14: There is no cause for alarm, but there may be a decrease in fertility in the foreseeable future.
15 and more: Excellent ovarian reserve, no limitations of fertility can be observed.

In some people, a blood sample shows a conspicuous value in the determination of the so-called "APC resistance" or there is a "Factor V Leiden mutation". These are factors that are important for blood clotting.

Blood clotting is an extremely complicated system of different factors that are supposed to interact in such a way that the blood neither clots without cause nor remains fluid for too long if, for example, there is an injury. If the blood coagulates in the vessels for no reason, it is called a "thrombosis". In this case, a clot forms that can easily block vessels.

Patients who have a conspicuous APC resistance test or who have a factor V Leiden mutation tend to develop thrombosis more easily. The risk is particularly high when other factors that promote thrombosis come into play, such as the use of hormone preparations, e.g. birth control pills, operations, bedriddenness, nicotine abuse, pregnancy, childbirth and breastfeeding.

This is why it is important to determine these two factors before starting hormone treatment, such as treatment with in vitro fertilisation. If there are any abnormal findings here, a concomitant treatment with anticoagulant medication, such as heparin, must be considered.

A sufficient supply of progesterone during the time of implantation is important. There are various progesterone preparations. One important preparation is "Arefam". It is usually swallowed, but it is also very well absorbed through the vagina. It also makes you less tired when used in this way. Therefore, please do not be confused by the package insert if you are supposed to insert the capsules into the vagina. This is fine and is what our medical team suggests.

However, after inserting the soft capsules, you may experience a whitish, greasy discharge, which is completely normal for this application in the vagina.

Detailed explanation of Arefam

There are two crucial phases in the menstrual cycle: 1) the so-called "follicular phase" and 2) the so-called "corpus luteum phase", which is also called the "luteal phase".

In the follicular phase, a follicle matures, which contains the egg cell that can be fertilised by a sperm cell after ovulation. As soon as the contents of the follicle have emptied into the fallopian tube together with the egg cell at ovulation, the follicle transforms into the corpus luteum. However, the follicle not only takes care of the egg, it also produces oestrogen, an important hormone that helps the lining of the uterus to grow again after menstruation. The corpus luteum, in turn, mainly produces progesterone, which the mucous membrane "takes over" from the oestrogen, so to speak, and prepares it for the implantation of the egg and thus for pregnancy. This is where the name pro gestare, i.e. for pregnancy, comes from.

A sufficient supply of progesterone during the period of implantation is therefore always important, regardless of whether sexual intercourse, insemination or treatment with IVF is to lead to success. Progesterone can be used as a medicine in various forms. One important preparation is "Arefam", which contains progesterone in a special dosage form. The preparation is normally swallowed, but it is also very well absorbed through the vagina, i.e. "vaginally", so we often prescribe it this way. It also makes you less tired when used in this way. So please do not be confused if you read in the package insert that you should swallow Arefam and we have prescribed that you should insert the capsule into the vagina. It is intended by our team of doctors. 

However, after inserting the soft capsules, you may experience a whitish, greasy discharge, which is completely normal for this application in the vagina.

Artificial intelligence (AI) is a branch of computer science that deals with the automation of intelligent behaviour and machine learning. In general, artificial intelligence refers to the attempt to emulate certain decision-making structures of humans, for example by building and programming a computer in such a way that it can process problems relatively independently.

By using artificial intelligence, we are continuously developing treatments and thus achieving a higher success rate.

Prof. Heinz Strohmer, co-founder of the Kinderwunschzentrum an der Wien, is Austria's thought leader in the field of AI and fertility medicine. Together with him we are currently exploring the impressive possibilities of using artificial intelligence in fertility treatment.