Ideal preparation for pregnancy The following examinations are recommended before the start of a fertility treatment: 1) Rubella or varicella antibodies If an expecting mother is infected with rubella during pregnancy, the virus can cause severe damage to the unborn child. An infection with chickenpox during early pregnancy can lead to severe abnormalities. If the infection occurs close to the birth date it is often fatal for the baby. A simple blood test can show whether you have protection against these viruses, either because you had the illness already or you were vaccinated. If you are lacking protection an injection should be conducted. After the last rubella/varicella injection you should wait 1 month before starting fertility treatment. 2) Infectious diseases Sexually transmitted diseases are infectious diseases which are mainly transmitted through intercourse. These diseases include hepatitis, HIV, syphilis or chlamydia. They can be transmitted to the unborn child and can cause miscarriage, premature birth or deformities of the child. In order to exclude a risk for the child, couples have to undergo testing of their blood for hepatitis, HIV and syphilis before fertility treatment. Furthermore, a urine test for chlamydia is required. These examinations are legal requirements and are regularly checked by the Ministry of Health via the Austrian Agency for Health and Food Safety (AGES). The results cannot be older than 3 months before the first fertility treatment and have a validity of 2 years. 3) Blood type Rhesus factor intolerance can occur during pregnancy if the rhesus factor of the mother is different from that of the child. If a rhesus negative woman is expecting a rhesus positive child, antibodies may be formed against the infant s blood. This can then be severely detrimental to a child in a later pregnancy. If this type of blood group incompatibility is known in advance, it can simply be remedied by antibody treatment. 4) Blood coagulation It is known that women with blood coagulation malfunctions and thrombosis risk statistically have more miscarriages than normal. It is possible that problems in the blood circulation at the nidation point of the embryo are responsible for this. This can also mean that these women have a higher risk of thrombosis under hormonal treatment as well as during pregnancy. The most common genetic risk factor in the European population (approximately 5% of Europeans) is the so-called APC resistance. This can be determined with a simple blood test. In addition, there are a large number of rare disorders where medical clarification is not an obligation. You will find the necessary information at the end of this document in case you would like to conduct these examinations. Version 1 from 01/2017 1
5) Cancer prevention for both partners Despite having a treatment at the Kinderwunschzentrum it is essential to visit medical specialists for check-ups and cancer prevention in regular intervals. Your gynaecologist will supervise you throughout your treatment and will conduct regular Pap smear examinations in order to recognize the occurrence of cervical cancer. Your breasts should also be regularly checked via palpation by your gynaecologist. Furthermore, an examination of the breast via mammography should be conducted from the 40th year of age. These examinations have a high significance in the early detection of breast cancer. For men, the urologist will conduct a prostate exam; this should be conducted once a year from 45 years of age at the latest. 6) Hormonal assay The hormonal balance is an important factor for conceiving. Hormonal imbalances can lead to defects in the oocyte maturation, absence of ovulation and to inadequate progesterone levels which in turn can lead to implantation failure. For this reason, we recommend a hormonal assay blood test to be taken between the 1st and the 4th day of the cycle to determine the following parameters: FSH, LH, estradiol, prolactin, testosterone and progesterone. With a blood test immediately before or on the day of ovulation it can be determined if and when ovulation takes place. Blood tests in the second half of the menstrual cycle (luteal phase) can test whether your hormones are creating the ideal conditions for an implantation of the embryo. A special role can be attributed to the hormonal parameter of the ovarian reserve. For this the determination of the anti-mullerian hormone (AMH) is important. Although not 100% accurate, this hormone nevertheless gives reliable information whether and to what extent the ovaries will react to hormonal stimulation. A possible extreme reaction ( hyper stimulation ) can also be predicted. We recommend the determination of the AMH parameter for women above the age of 38 or in cases where FSH>10. In younger women the determination can be useful in order to assess the ovarian reserve and to optimally customize hormonal stimulation. 7) Thyroid Disorders of the thyroid gland can cause irregular menstruation, reduced fertility, increase the risk of abortions and be detrimental to the child s mental and physical development. For these reasons we recommend a test of the TSH parameter as well as the TPO antibodies before the start of fertility treatments. In case of abnormalities it is helpful to consult a thyroid specialist before starting a treatment. 8) Vitamin D Vitamin D deficiency can negatively affect fertility, embryo implantation and the chance of pregnancy. A link is suspected between vitamin D deficiency and various diseases during pregnancy such as high blood pressure, preeclampsia (pregnancy poisoning) or pregnancy diabetes. 9) Vaginal infections The vagina is constantly populated by Döderlein bacteria. If, however, the pathological colonization with other bacteria or mycosis prevails then an appropriate therapy will alleviate symptoms and facilitate pregnancy. During pregnancy the colonization of the vagina or the uterine neck with germs can lead to premature birth or miscarriage (see point 2). This means it is especially important to diagnose an infection before fertility treatment. A pathological colonization can be determined by your gynaecologist via a bacteriological smear and examination in a laboratory. Version 1 from 01/2017 2
10) Spermiogram The most important examination for men with an unfulfilled wish for a child is the spermiogram, the examination of the sperm sample. If done at the start of the diagnostic examinations, this can save his partner from unnecessary and stressful examinations or treatments. For this, he has to deliver a sperm sample after 3-5 days of abstinence. After liquefaction the following parameters are determined: volume, number of sperm cells per milliliter, which percentage of sperm cells is rapid moving, slow moving and which percentage shows normal morphology. Sperm results are subject to fluctuations which could mean that more than one test is necessary. In case of a normal result (normozoospermia) a further checkup is not necessary. If the results are abnormal we recommend a check-up at the earliest 4 weeks later. The following examinations are not obligatory, however, they can be conducted if desired. Not all examinations are necessary or recommended for all couples: 11) Coeliac disease Coeliac disease is the most common autoimmune disease worldwide, affecting roughly 1 in every 100 people. For some time, a link has been suspected between gluten intolerance and unexplained infertility (idiopathic sterility). Women with idiopathic sterility are 5 times more likely to have gluten intolerance and women with repeated stillbirths are even 6 times more likely to have the condition compared to the remaining population. Symptoms in some affected women appear initially in the form of irregular periods or infertility. A blood test can show specific antibodies which indicate coeliac disease. 12) Tubal patency test The oocyte awaits fertilization in the outer third of the fallopian tube. After intercourse, the sperm cells migrate through the uterus and into the fallopian tubes until they reach the oocyte. After that the fertilized oocyte remains in the tube for several days while it is transported into the uterus. Without doubt, the patency of the tubes is an important factor in the achievement of spontaneous pregnancy. The test can be conducted using x-ray, laparoscopy, or with a special foam which can be tracked using ultrasound. These examinations are usually only necessary if no in-vitro treatment (IVF) is planned. If the spermiogram results of the male partner are normal it is recommended that this examination be conducted before the first consultation. Otherwise, this will be discussed during the consultation. 13) The uterus After fertilization in the fallopian tube the embryo reaches the uterine lining within several days. If it can implant successfully, pregnancy begins. This process can be disrupted by the existence of malformations, myomas, adhesions or a partitioning wall (septum). Through ultrasound myomas and sometimes a septum can be diagnosed. Certain malformations or adhesions which can occur after curettage are better diagnosed via hysteroscopy and can then be operatively corrected at the same time. This procedure is usually connected with an inpatient stay at the hospital. Version 1 from 01/2017 3
14) The genetic material (chromosomes) A healthy cell has 46 chromosomes which contain the complete genetic information. In rare cases a defect in the genetic material exists and can mean one part of a chromosome has been transferred to another chromosome (translocation) or is missing completely. These simple defects can be detected by blood test (karyogram). The alteration of certain genes which transmit specific genetic diseases to the child cannot be detected with this method. Depending on the reasons for infertility, a higher risk for chromosome anomalies (changes in genetic material) can be existent in some couples. In cases of diminished sperm quality the risk of microdeletions of the Y-chromosome ( missing piece of the Y-chromosome) is higher. A blockage in the spermatic ducts can mean a mutation in the CFTR gene (gene for the presence of cystic fibrosis, meaning mucoviscidosis). If such changes are prevalent it can mean a transferal of the abnormal gene material to the child. If the partner is also a carrier of genetic changes this can lead to the manifestation of certain diseases. The most common genetic changes in cell material (also in healthy carriers ) are mucoviscidosis (cystic fibrosis) and thalassemia. 15) Immunological examinations The nidation of the embryo and the further development in pregnancy until birth can fail if the embryo or later child is rejected. This can happen if the immune system of the mother has a disorder. It is possible to have a blood test done to test for indications of such a disorder. We would like to point out that the value of such a blood test is not guaranteed according to current data and that there is no proof that many of the immunological treatment methods lead to an improvement in success rates. A healthy lifestyle, wholesome food, a balanced inner life and a happy relationship will be beneficial for your fertility and your future child. Take sufficient time and think about how you can do your child something good even before you conceive. Further recommendations for preparation for a healthy pregnancy: Dietary supplements As soon as you are planning pregnancy it is recommendable to take a daily dose of folic acid (400 ug). A sufficient supply of folic acid can prevent spina bifida (open spine), neural tube defects and other malformations in the child. In order to build up a sufficient level and to make sure that the embryo is supplied in the first critical weeks of pregnancy, the intake of folic acid should start at least 4 weeks but optimally 3 months before the occurrence of pregnancy. Vaccinations Please conduct all necessary vaccinations such as influenza, pertussis (whooping cough), tetanus, hepatitis, FSME etc. if possible before your fertility treatment. Version 1 from 01/2017 4
List of above-mentioned examinations which can be conducted at the Kinderwunschzentrum or partner institutes: Cooperating partner for blood tests & spermiogram: Laboratory Endler Währinger Straße 63, 1090 Vienna (across from the Volksopera) T +43 1 408 31 31 Opening hours: Mon-Fri 7am 2pm, Sat 8am 10am 1) Rubella or varicella antibodies (Laboratory Endler) Rubella antibody determination private service 19 Varicella antibody determination private service 12 Necessary booster shots should always be conducted by your general practitioner, gynaecologist or health authorities (MA 15)! Rubella vaccination: MMR-vaccine combination (measles, mumps, rubella) 30,75 PRIORIX-vaccine combination (measles, mumps, rubella) 29,70 Varicella vaccination: VARILRIX-vaccine (single vaccination) 65,20 2) Infectious diseases (Laboratory Endler) Hepatitis, HIV, syphilis, chlamydia 3) Blood type (Laboratory Endler) Blood type & Rhesus factor once after that: private service 30 4) Blood coagulation (Laboratory Endler) Basic examination = APC resistance Further diagnostics: e.g. complete thrombophilia diagnostic Univ.Doz.Dr. Michael Halbmayer http://www.halbmayer.at/ private service, price on request 5) Cancer prevention (your gynaecologist or urologist) PAP (cancer smear), prostate examination 6) Hormonal assay (Laboratory Endler) Hormonal assay (FSH, LH, E2, etc.) Anti-Mullerian-Hormone (AMH) private service 50 Fertility test & screening Juno institute, private service Version 1 from 01/2017 5
7) Thyroid First examination including ultrasound private service 140 Schilddrüsenpraxis - Univ.Doz.Dr. Georg Zettinig http://www.schilddruesenpraxis.at/ Woman & Health - Dr. Bamdad Heydari http://www.womanandhealth.at 8) Vitamin D (Laboratory Endler) 9) Vaginal infections (your gynaecologist or Pilzambulatorium Vienna) Smear & bacteriological culture, chlamydia smear 10) Spermiogram Urologist of your choice price on request at Laboratory Endler (with referral from us) at the Kinderwunschzentrum private service 100 11) Coeliac disease (Laboratory Endler) Complete-IgA, Transglutaminase-IgA antibodies Endomysium-IgA antibodies private service 12 12) Tubal patency test Tubal patency x-ray (HSG) X-ray Ordination Goldenes Kreuz T +43-1 - 40 111-8500 Laparoscopy (LSK) Referral to gynaecological department by gynaecologist Ultrasound with hydrosonography (HyCoSy) private service 260 Kinderwunschzentrum 13) Uterus (gynaecological department) Hysteroscopy (HSK) In the framework of an inpatient hospital stay (Vienna) or outpatient day clinic (lower Austria, esp. Tulln) 14) Genetic material - examinations Chromosome analysis (Karyogram) e.g. Institute medgen http://www.medgen.at/ private service approx. 260 15) Immunological examinations Immunological examination Immunological day clinic http://www.itk.at/ deductible depending on health insurance The above list is only a reference guide regarding addresses and prices and makes no claim to completion. The prices for the listed examinations can change and should be enquired at the respective institute. Version 1 from 01/2017 6