Are you thinking of embarking on an assisted reproduction journey? The first step is to book a consultation with our professionals. Every story is unique and therefore every single patient – as well as every couple – is invited to talk about their journey and their goals, in order to evaluate together what are the steps to take for a totally personalized assisted reproduction process.

With a simple blood sample we carry out hormonal analysis, i.e. the monitoring of your hormone levels in the blood. Through this examination we can identify hormonal imbalances, understand the cause and intervene with the right remedies.

Ovulation monitoring takes place through a series of transvaginal ultrasound scans and has a dual function:

✔on the one hand it’s used to check that ovulation happens

✔on the other hand it’s useful to increase the chances of conception with targeted intercourse

This examination is essential for all couples who decide to plan a pregnancy, but also for women who undergo ovulation induction therapies.

The spermogram is the first laboratory test a man should undergo when infertility is suspected in the couple. It is a diagnostic test to analyze seminal fluid to evaluate the quality, number, shape and motility of spermatozoa. A spermogram is useful not only for diagnosing the state of infertility, but also as an examination for the prevention of possible pathologies.

Ovulation is the time in the menstrual cycle when a woman reaches her maximum level of fertility and is therefore ready to conceive. Ovulation occurs about 14 days before the arrival of menstruation and can be characterized by symptoms such as abdominal cramps, enlarged breasts and cervico-vaginal secretions.

Follicogenesis, i.e. the maturation process of the follicles, begins during puberty and can have two outcomes: the death of the follicle (or atresia) or ovulation. Follicogenesis begins at puberty and ends with the menopause.

For those who decide to embark in assisted fertilization, it is useful to estimate the ovarian reserve, ie how many follicles are present in the woman’s ovaries at a given moment in her life. Age, genetics, surgical interventions and therapies that can compromise fertility in fact influence the ovarian reserve of every woman.

Correct nutrition can benefit fertility. A balanced diet and a healthy lifestyle help both women and men to take care of their fertility. It is no coincidence that the holistic approach to assisted reproduction, employed by CFA, also includes personalized advice by our nutritionist, whose advice accompanies the couples throughout their journey in search of a child.

Hysteroscopy is an endoscopic procedure that allows you to diagnose some pathologies of the uterine cavity. The examination takes place in the clinic and consists in observing the inside of the uterus through a hysteroscope, equipped with a camera, that allows to us identify malformations of the uterus or the presence of polyps, fibroids or tumours. Hysteroscopy is very useful for understanding the cause of infertility and is therefore usually recommended for women who want to embark in assisted fertilization.

Polycystic ovary syndrome (also known as PCOS), is one of the main causes of female infertility, but not all symptoms are attributable to this pathology. Let’s consider the most common:

● the first alarm bell is the irregularity of the menstrual cycle

● often this syndrome is only identified when the couple try to conceive

● in many cases there is unexplained weight gain

● Hormonal imbalances are common, causing acne and hair on the face and chest

It is very important not to ignore these symptoms, but to talk about them with your gynaecologist to be directed

towards the right treatment.

To increase the chances of conception, intercourse programmed for the ovulatory period is recommended. The so-called “fertile window” – the period of the month in which the woman is most fertile – is recommended for getting pregnant, given that the possibility of conception in the ovulation phase is higher. But beware of the emotional stress that can result from this practice.

Embryo transfer, perhaps the most important moment in ART, is where the embryo is literally transferred from the laboratory to the woman’s uterus. Embryo transfer is a delicate procedure, but one that shouldn’t cause concern for the patient. The fear of failing ART and therefore seeing their dream fail, causes psychological stress and therefore we invite our patients to relax at CFA for about an hour after embryo transfer. It is not absolutely not necessary to stay in bed after transfer, but our advice is to resume daily activities, avoid excessive physical exertion, sources of stress and maintain a healthy diet.

In this simple technique, semen is collected by masturbation from the male and treated in the laboratory to collect the highest number of motile sperm free from the semen liquid. It is concentrated into a small volume and transferred via a plastic catheter into the womans uterine cavity. IUI is a simple technique with a very modest success rate of 7-8%

and can only be applied to couples with normal sperm samples, open fallopian tubes and good ovulation that often needs to be primed pharmaceutically.

During a menstrual cycle, the ovary normally produces only one mature oocyte for ovulation. In order to improve chances of a pregnancy, ART procedures require a protocol of ovarian stimulation, with naturally occurring hormones, generally FSH, to generate several mature oocytes. There are many general protocols for stimulation using different hormones, but in all cases the actual protocol depends on the age and physiology of the woman and the type of ART procedure to be used.

There are three types of pharmaceuticals used for ovarian stimulation:

1. Gonadotrphins

2. Agonists and antagonists of GnRH

3. Different triggers to induce ovulation such as hCG.

Ovarian stimulation with FSH is usually performed by daily sub-cutaneous injections of FSH lasting 9-12 days.

In this protocol exogenous FSH is not used to stimulate the ovaries, rather the natural intrinsic hormones of the patient are utilized. Natural cycles are often used in patients with a known poor response to FSH stimulation and such patients are often over 40 years of age. It is still important to follow the follicular growth with frequent ultrasound measurements and blood serum levels of oestrogen.

IVF was first used over 40 years ago and upto date has led to the birth of over 10 million babies worldwide. This technique is the core procedure for ART

and involves immersing the womans eggs in a drop of culture medium containing spermatozoa of the partner. The fertilized eggs are then left to develop

in culture for upto 5 days and then subsequently transferred

into the womans

uterus with a

fine soft plastic cannula.

Heterologous fertilization is a medically assisted procreation technique which is used in couples with impaired gamete function. In this technique one, or both, of the gametes are replaced by gametes from an external donor.

IMSI, intracytoplasmic injection of morphologically selected sperm, permits the selection of the best sperm, using a high-magnification microscope, without staining and in real time Numerous studies show that the ICSI technique associated with high magnification sperm selection allows for greater success and a higher pregnancy index, especially in cases where sperm alterations are associated with a high DNA fragmentation index.

The IMSI technique is offered where:

• ICSI has previously failed

• for severe teratozoospermia;

• there is high DNA fragmentation in the spermatozoa

• in idiopathic,

• or unexplained, infertility.

ICSI, used for the first time in 1992, is an assisted reproduction technique which in recent years has revolutionized the treatment of male infertility, giving men with few sperm cells the possibility of becoming a father.

With this technique, thanks to sophisticated equipment, the single sperm is injected directly into the oocyte.

ICSI is applied:

– as a result of repeated failures with IVF

– in case of endometriosis

– in the presence of severe male sterility and frozen semen and/or oocytes

In order to maximize the success rates, the woman is subjected to hormonal stimulation (induction of multiple ovulation) in order to recruit as many oocytes as possible.

AZH is a micro-surgical procedure performed on embryos to create a lesion in the zona pellucida, the eggs protective coat, to increase the chances of implantation and pregnancy. The embryo, after reaching the blastocyst stage, must hatch out of the envelope that surrounds it, called the “zona pellucida”, to then implant itself in the uterus and begin to receive oxygen and nutrients from the mother. AZH allows the zona pellucida of the embryo to be thinned using a laser before transfer to the uterus. In this way we favour the implantation of the embryo in to the uterine wall.

It is recommended:

– in women of advanced reproductive age (>38 years)

– when the levels of follicle stimulating hormone (FSH), on the third day, are particularly high

– in cases of repeated failures with in vitro fertilization techniques

– when, simply, a thickened zona pellucida is visible in the embryo.

Egg donation is the donation of eggs by a woman to another woman. This assisted fertilization technique takes place in complete anonymity, to respect the privacy of both the donor and the recipient. Choosing to donate your own oocytes is an act of great sensitivity, as it allows many couples to make their dreams come true. In fact, many women, due to pathologies, treatments such as chemotherapy or radiotherapy or age, have problems with their oocytes and today, fortunately, they can resort to egg donation. Eggs can be donated by healthy young women who are free from hereditary diseases. Egg donation is a gift, a gesture of solidarity, by which many women have conceived and given birth to their long wanted child.

Sperm donation is a voluntary act that allows men to donate their sperm so that it can be used in assisted reproduction techniques, helping many couples who are unable to have children. Sperm donation, like egg donation, takes place completely anonymously and not before the donor has undergone a series of genetic tests to avoid the risk of hereditary diseases. The sperm itself undergoes a period of quarantine in which it is ensured that there are no sexually transmitted diseases present.

The technique, called freeze all, has emerged as an alternative to fresh embryo transfer (ET) during in vitro fertilization (IVF) cycles. This procedure consists in the freezing and cryppreservation of all oocytes or embryos obtained from ART to transfer in a subsequent natural cycle.

We speak of Dual stimulation or DuoStim when during a single menstrual cycle two stimulations and two collections of oocytes are performed in the follicular and luteal phases. The DuoStim protocol is particularly effective in women in whom it is necessary to optimize the ovarian reserve, such as cancer patients or elderly patients.

TESE, testicular sperm extraction (or testicular biopsy) involves the extraction of small pieces of testicular tissue by a surgeon which is then immediately controlled in the laboratory for the presence of spermatozoa under the microscope. The tissue, after being classified as containing sperm, is then frozen for subsequent use in IVF. Thanks to this technique many azospermic men have been able to father children.

When choosing to embark in ART, both partners need psychological support. In fact, we must not underestimate the effect that stress can have, not only in the presence of any IVF failure, but also during the entire period of examinations and treatments to which one undergoes before the transfer. At CFA, our patients are supported by our pscychologists from the first consultation to the realization of their dream of parenthood.