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- Goce Delchev 85/a – Shtip
- contact@organdziski.com
The compulsory examinations by our gynecologists include:
For the female patients we need:
Insemination is an elective method that we do when the sterility isn’t presents for more than a year, when the female patient is younger than 35 years of age, when the fallopian tubes are clear, when there are enough egg cells and enough follicles in the ovaries, when the sperm count test shows the diagnosis of: Normozoospermia, Asthenozoospermia or light Oligozoospermia.
Insemination is an assisted natural fertilization process. We stimulate the ovaries with medication in order to get at least 1-2 follicles. The moment they are 16-18 mm wide, a stop injection is administered in order to insure safe ovulation.
On the day of the scheduled insemination, you partner should provide sperm in a sterile cup. The sperm is then processed and only the highest quality spermatozoids ate inserted into the womb via a thin catheter. During the next 15 min, the spermatozoids should enter the fallopian tubes and fertilize the egg cells. The drawback of this procedure is that we cannot be sure whether there are mature egg cells in the follicles or whether the conception will take place.
In case such as the following, we recommend not to waste precious time and to go for the IVF directly:
In any case, we will plan out the treatment with you, every case is individually treated.
In the “Dr. Organdziski” hospital, we do the HSSG exam, which is completely painless. We would slowly administer 20 ml od colored liquid into the womb via a thin catheter. The liquid penetrates the fallopian tubes and passes through them and past them. The process of injecting the liquid could cause slight discomfort, but slight pain would be felt only if the fallopian tubes are clogged and, once we see that on the sonogram, we stop the procedure and discuss other examinations.
This diagnosis means:
It should not cause major concern, but you should get treatment:
You will have a control check-up after 1-2 months. If there aren’t any signs of improvement, you should consider IVF.
We have been granted a consent for IVF from the Fund.
How can we use it in your hospital?
Are there any additional costs?
The “Dr. Organdziski” hospital in Shtip has signed a contract with the Health Fund. It would be our pleasure if you choose us to help you achieve your wish- healthy offspring. If you haven’t visited our hospital so far, schedule a check-up with our gynecologists and bring your consent from the Fund. Also make sure you bring with you result from all the previous examinations you have done. Our nurses will open a patient’s file for you and we will put copies from those results in your dossier.
You should also schedule a sperm count test for your partner, making sure you have a 2-5 days abstinence period before the examination is done. Right after that we will create a treatment plan for you and we will give instructions on how to proceed and when to prepare the papers from your personal gynecologist.
So additional examinations might be required, but you would be duly notified. Please keep in mind that the IVF Consent from the Health fund has limited validation date of short 6 months after it has been issued. Should you use up to 22 ampoules for suppression and up to 30 vials for stimulation (as is provided by the Fund), you would not have any additional costs. If treating you requires more ampoules, (if the female patient has sparse ovarian reserves), you might be asked to pay, but you will be duly informed for every detail of your treatment.
Explain the procedure to me!
What should I expect?
On the second day of your menstrual cycle, you would start with medicine such as “Jasmin” or “Microgynon”, taking one pill per day, around the same time every day. By the time you are taking the 16th or 17th pill, you should schedule a check-up. The ovaries should be clear, there shouldn’t be any cysts.
You then start with the suppression medications, to settle down the ovaries, i.e. you inject yourself every morning around your bellybutton. These injections are very simple and we would instruct you on how you can do them yourself. Unless our doctor advises you otherwise, you should continue and finish drinking the pills. 5-7 days later, you would get your menstrual cycle. It can be weaker, do not worry, just let us know!
On the third day of your period, we would do an ultrasound check-up to make sure that the ovaries are calm and we do a hormonal status. We would start you on stimulation medication which should be administered in the afternoon. Our doctor would decide on the dosage on the next check-up date. The stimulation period usually lasts for 8-9 days and then our doctor would determine when to administer the stop injection. 36 hours later we would do the punction to aspire the egg cells. You would be asked to come for this procedure hungry and thirsty (on an empty stomach) about an hour prior to the aspiration procedure. The process is done with a short-term local anesthetic so you would feel no pain whatsoever!
Afterwards, you would be informed on the number of retrieved egg cells and you husband would be asked to provide us with his semen. You would be prescribed medication for the next 2-3 weeks (up until the pregnancy test). This is the day we wall DAY 0 i.e. it is a day to rest and relax after the procedure. You might feel slight pain but, do not worry, if there is some pain it will dull out the very next day! You should spend the time relax because the very next day our embryologists would inform you about the number of fertilized egg cells and how they are developing.
This is day 1, when we check the fertilized egg cells. We can see the conception has taken place when there are 2 pronuclei – one from each parent. On day 2, the embryos should be divided into 4 blastomeres, although there could be alternations and there could be 2-3 or more blastomeres. On day 3, the ideal embryos are cleaved into 8, equally sized blastomeres. If there are any abnormalities with the cell division, do not be disappointed because this is the purpose of treating every retrieved cell – in order to have multiple cells and choose the best for you. On day 4, the embryos are in the so-called morula state – they are compacted. On day 5, the embryos should be at the blastocyst point. This is the day the embryo transfer is made. It the best stage of the process, when we return the best one to two embryos in your womb. This is done via a very thin catheter and you shouldn’t sense any pain. You would remain in the OR for an hour more and then you go home.
It is recommended that you relax and rest for the next two days because those are the crucial days when implantation should occur- the embryo should embed in the uterus.
Afterwards, you can go back to work but keep in mind to avoid stress and heavy lifting. If your job involves physical effort or psychological stress, your resident gynecologist should prescribe a 2-week sick leave for you.
14 days after the embryo transfer, you should do a blood test for pregnancy. If it is positive, you should continue taking the medicine prescribed by our doctors and we would schedule an ultrasound check-up in 7-10 days, in order to confirm the presence of one or two sacks.
The fertilization can be done with a classic IVF – when we add the processed spermatozoids (the best once separated with the SWIM UP method) to all the aspired egg cells. The spermatozoids are left to fertilize the egg cells by themselves, mimicking natural conception. This is performed when the sperm count test has shown a sufficient number of normal spermatozoids in the semen.
ICSI is a method of assisted IVF- one spermatozoid is selected using an inverted microscope and it is injected into an egg cell. This IVF alternative is done when there are fewer viable spermatozoids, when there are fewer available egg cells or when a classic IVF hasn’t been successful. Also, we recommend using the ICSI method when a donor semen or donor egg cells are used in the IVF process.
Legally, we could transfer 1 or 2 embryos at a time. 3 embryos could be transferred only after 2 unsuccessful IVF treatments.
If there are multiple good quality embryos in the blastocyst phase, we could cryopreserve some of them and store them for a next possible procedure. In our hospital, we use the most modern Vitrification process to ensure high percentage of embryo survival.
Should you not conceive in the first try, this allows you to skip the phases up until embryo transfer and try one more time.
If you conceive one baby, these cryopreserved embryos would wait for you should you be ready for another baby.
In case the female patient has depleted ovarian reserves, the gynecologist could suggest a spontaneous cycle punction- without ovarian stimulation or with only mild stimulation. We would get only 1 or 2 egg follicles.
If there are egg cells in them, they are fertilized via the ICSI method.
This can be tried every month, there is no reason to pause between two IVF procedure as with the stimulated ovaries cycles.
In order to import donor cells, you need a consent from the State Commission and you need to have sourced out a suitable donor that matches your characteristics: eye color, hair color, height, blood type. It is of utmost importance to keep in mind that we cannot import egg cells from the same donor more than once, here in Macedonia. An examination is in order, you should bring the AMH results and our specialists should give their Professional opinion alongside the following documents:
After you have been granted consent from the Fund, it could take a few months for the import of the cells to take place. Remain calm and persevering. Be careful! The Fund consent covers the IVF procedure, it does not cover the cost for the donor egg cells – you would have to pay for that yourselves.
In the meantime, if you don’t get regular periods, our gynecologists would prescribe medication to have regular menstrual cycles in order to have a uterus ready and susceptible for the embryos we would get in the process.
We require 3 sperm count tests to be carried out If all 3 tests show absence of spermatozoids. We would do a hormonal status examination followed by testicular biopsy and a karyotype test.
The following documentation should accompany our professional opinion:
After you have been granted consent from the Fund, it could take a few months for the import of the semen to take place, so be patient.
For the IVF procedure with donor spermatozoids the process is the same as previously mentioned. On the day of the punction, the spermatozoids are thawed and by implementing the ICSI procedure, they are injected into the egg cells – one spermatozoid per egg cell.