As part of your forthcoming treatment we have prepared the following
questionnaire, which serves to facilitate the communication between you and our
physician. Please complete the questionnaire by filling out all the required
data. Do not hurry, take your time. The information in the questionnaire is very
important and will help the physician with designing the best treatment option
for you. The questionnaire also includes your identification data, which is
required to draft the Application for Treatment.
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Thank you for your assistance, we are wishing you a successful treatment.
Used stimulation protocol Which type of stimulation protocol was used: - short (with so called antagonists Orgalutran, Cetrotide) - long˝ (with so called agonists Decapetyl, Diphereline, Synarel)
FSH dosage What was the daily dosage of stimulating hormones: - e.g. 100, 125, 150, â€¦ units(Puregon, Gonal F) - or 1, 2, 3, 4, 5â€¦ ampoules (Menopur, Merional, Fostimon), 1 ampoule = 75 units
Follicle growth at OPU how many follicles there were at the last ultrasound examination before retrieval of eggs/OPU (OPU = ovum pick-up)
ICSI used? Were the retrieved eggs fertilized with ICSI method (Intracytoplasmic sperm injection)
Embryos for transfer? How many embryos altogether were available on the day of embryotransfer
Vitrified embryos? How many embryos were vitrified
Conclusion The result of IVF cycle (delivery / miscarriage / negative pregnancy test)
Vysvětlivky k tabulce:
Year in which you underwent the treatment
How many embryos? Number of embryos which developed from a donor egg fertilized by the sperm
Embryos for embryotransfer? How many embryos altogether were available on the day of embryotransfer
Vitrified embryos? How many embryos were vitrified
Conclusion The result of egg donation treatment (delivery / miscarriage / negative pregnancy test
What is semen analysis?
It is a microscopic examination of a semen sample revealing possible abnormalities.
To ensure contribution of spermiogram evaluation, semen analysis shall be carried out after 3-4 days of sexual abstinence and a sample obtained by masturbation shall be handed to the laboratory within 30 minutes. In the laboratory, number of sperm per 1 ml, their motility and shape of heads, necks and tails;/strong> (morphology) is evaluated. If the sperm analysis shows any abnormality, the procedure should be repeated within 2 up to 3 months and just after recurring abnormalities, it is recommended to see the urologic or andrologist (specialist on male infertility).
What is transvaginal ultrasound?
Vaginal ultrasound visualizes organs in pelvis minor (mainly the uterus and ovaries). A probe is inserted into the vagina at vaginal ultrasound.
Endometrium is the inner membrane of the uterus. Ĺ Endometrial thickness changes according to the phase of menstrual cycle.
Uterine polyps are growths that occur in the endometrium. They may occur in the uterine cavity or in the cervix. The most common symptoms of polyps are irregular bleeding between periods or unusually heavy menstrual bleeding. Polyps are removed hysteroscopically.
Uterine myoma(= fibroid) is a tumor from smooth muscle tissue that originates from the smooth muscle layer. Bleeding or pain may occur due to myomas and they may negatively infuence women's fertility.
Ovarian cyst is an accumulation of clear or yellowish fluid within an ovary that is surrounded by a very thin wall. According to the characteristics and the way of development of a cyst, the cysts are divided into: follicle cyst, lutein cyst, endometrial cyst, hemorrhagic cyst.
More about hormones in view
FSH = follicle-stimulating hormone
LH = luteinizing hormone
E2 = estradiol
TSH = thyroid-stimulating hormone
PRL = prolactin
AMH = anti-mullerian hormone
Please enter also the units, in which a collection is carried out
What is hysterosalpingogram?
The examination may be carried out in a modern way under ultrasound control (sono HSG) or under X-ray control (RTG HSG).
At present we prefer sonoHSG as the examination is painless, we do not load the patients with X-rays and the method is widely accessible.
HSG procedure enables visualization of the shape of the uterine cavity and patency of fallopian tubes (i.e. we can see whether contrast medium passes through fallopian tubes into the abdominal cavity).
What is laparoscopy?
Laparoscopy belongs to so called minimally invasive surgeriesdone under general anesthesia. A thin camera is inserted through a small incision in the navel area and the abdominal cavity is filled with gas creating visual space inside the pelvis. Other 1-2 penetrations serve to insert necessary surgical instruments.
It is used for diagnosis andendometriosis treatment and forexamination of patency of fallopian tubes as well. Also diagnosis of post-inflammatory conditions and post-operative adhesions after prior surgeries is carried out laparoscopically.