The first visit to the Biofertility Clinic is always carried out personally by Prof.
The meeting generally lasts an hour and a half, because first of all it involves evaluating two patients (the Woman and the Man).
In reality it can last longer because its complexity cannot be established a priori, especially when it comes to very difficult cases with repeated failures.
When it is not possible to go to the Clinic, you can proceed with an online video consultation, especially for those who live outside Rome, collecting all the tests previously done by the couple and consequently the medical record is opened.
At the first visit, an accurate general anamnesis of the couple is carried out, in particular the following are assessed: Previous and current pathologies (in particular pcos, reduced ovarian reserve, endometriosis) Tests and analyzes already carried out Previous attempts at PMA Transvaginal ultrasound with antral follicle count (possibly in the first days of the cycle) Once all the data has been collected, the Professor formulates his own diagnosis of infertility or a plan of tests and analyzes to deepen it and often on on the basis of this, he begins to prescribe specific therapies to: improve ovarian reserve and oocyte quality (this is possible based on data from scientific literature and our experience); increase blood flow in the uterus when the endometrium does not grow with specific drugs; reduce inflammation and oxidative status in the endometriosis with suitable pharmacological substances; improve the metabolic and inflammatory state in Polycystic Ovary Syndrome (pcos) with all the drugs and probiotics most suitable for the individual type of pcos DIAGNOSTIC TESTS Antral follicle count The follicles smaller than 10 mm in the 2 ovaries are identified and counted.
It is performed with a transvaginal ultrasound in the first days of the menstrual cycle. It tells us how many follicles are still available to the ovaries to predict the ovarian response to their hormonal stimulation which occurs especially during a PMA.
It is probably the best method to evaluate a woman's ovarian reserve. 3D gynecological ultrasound Allows you to see an image of the uterus in three dimensions.
It is mainly used for the evaluation of uterine malformations and myomas. Hysteroscopy Endoscopic examination to examine the internal surface of the uterus.
Through the use of a tiny camera connected to thin optical fibers it allows you to directly see the cavity of the uterus and its internal lining or endometrium.
It is used to diagnose numerous pathologies and then treat them. These include endometrial polyps, uterine septa, submucosal myomas, synechiae (or internal adhesions), malformations such as the T-shaped uterus.
It is completely outpatient and lasts a few minutes. Hysterosonosalpingography Diagnostic procedure capable of evaluating whether the tubes are open.
It therefore allows us to understand whether the passage of the spermatozoa and the meeting with the egg is possible.
Occlusions and other types of alterations of the organs (fallopian tubes or salpingi) that connect the uterus to the ovaries are seen.
It is completely outpatient and lasts a few minutes. Follicular monitoring Ultrasound examination aimed at evaluating the growth of ovarian follicles and ovulation.
The growth and transformation of the endometrium where the embryo will implant is also evaluated at the same time.
It is the best tool to understand if ovulation actually occurs. Endometrial biopsy for plasma cell research Investigation used to identify the presence of chronic endometritis.
Chronic endometritis is an inflammation of the endometrium which can be caused by germs that infect it and can inhibit the implantation of an embryo and therefore pregnancy or cause miscarriage.
The search for plasma cells with this test indicates the existence of endometritis which must be treated before performing PMA and embryo transfer.
It is a completely outpatient procedure and lasts a few seconds. Endometrial biopsy for the evaluation of the "Implantation window" those days (or "window") in which the endometrium is ready to welcome the embryo.
Sometimes we find this period anticipated or postponed compared to the norm and the development of the embryo, no longer being synchronous with this period or temporal "window", is unable to implant.
It is also said that the endometrium loses its normal receptivity. Therefore, diagnosing whether there is an anomalous shift in the "endometrial implantation window" can help us understand a possible cause of failed embryo implantation.
In this case, the receptivity will be adjusted with specific synchrony protocols between the development of the endometrium and that of the embryos to be transferred. Endometrial scratching. Small mechanical stimulation of the endometrium to encourage the embryo to take root.
It is performed especially in PMA after previous embryo implantation failures. It is completely outpatient and lasts a few seconds.
Spermiogram Laboratory test to evaluate a man's fertility. It consists in the study of the most important parameters of the seminal fluid including concentration, motility and morphology of the spermatozoa according to the international WHO criteria Sperm Culture Laboratory test for the research of pathogenic germs causing infections in the seminal fluid and in the male reproductive tracts and organs.
Swabs for chlamydia, search for common germs and mycoplasma HORMONE AND GENETIC ANALYSIS FOR FERTILITY Karyotype examination laboratory test to evaluate the number and structure of the chromosomes.
The aim is to look for anomalies that can cause infertility.
It is useful in case of possible early menopause. Genetic tests Tests to identify the genes responsible for cystic fibrosis before performing MAP.
If both parents are carriers of this disease the child could be suffering from cystic fibrosis Evaluation of thrombophilia.
It is performed with tests of genes that control the production and functioning of some coagulation factors.
A serious alteration of these genes (homozygosity of numerous factors simultaneously) can cause impaired blood coagulation and promote infertility and abortion.
Y chromosome microdeletions Blood test to look for the absence of small parts of the Y chromosome.
It is performed in case of serious conditions of the spermiogram (oligo-astheno-teratospermia and azoospermia) and can lead to the transmission of infertility to male children.
Sperm aneuploidy Test that identifies the percentage of spermatozoa carrying an abnormal number of chromosomes (aneuploidy).
QUICK PROTOCOL FOR THOSE WHO FIND OUT THEY ARE INFERTILE In 1-2 cycles (months) it is possible to make diagnoses such as complete infertility of the couple. Visit and ultrasound with antral follicle count on the 2nd day of the cycle with all hormonal tests for complete evaluation of the ovarian reserve and thyroid function, ultrasound monitoring of ovulation and cervico-vaginal swabs, after ovulation we carry out the ultrasound evaluation and hormone of the luteal phase.
It is possible to plan and administer the first therapies. At the same time in this first cycle the spermiogram is performed (the report of which is ready 1 hour after delivery of the seminal fluid) and possibly the sperm culture.
Already in this phase, if necessary, an initial andrological therapy can be implemented. The following month, hysterosonosalpingography can be performed to evaluate tubal patency and possibly hysteroscopy.
At this point a formal diagnosis of infertility and planning of complete therapy is generally possible.
It is possible to carry out all the couple's blood tests at the Biofertility center and carry out all the other consultations (andrological, nutritional, etc.) as early as the second month to complete the diagnosis and therapy.
This grouping of tests at our center allows us to avoid wasting time and dispersions for a unified control of diagnosis and therapy.