Treatment methods

Treatment methods at the Fertility Centre Niederrhein

Sometimes it turns out already after the first questioning: The sexual intercourse was too rare or at the wrong time. Cycle control and sex at the right time will help. If, however, a disturbance in egg cell maturation has been found, medication is usually necessary.

Assisted hatching (laser slipping aid)

With assisted hatching, an opening is made in the zona pellucida surrounding the embryo immediately before the embryo transfer in order to make it easier for the embryo to leave the zona pellucida and thus enable it to implant in the uterine lining. This procedure is recommended for patients 38 years and older, for the transfer of embryos derived from cryopreserved oocytes and for couples who have already undergone 2-3 IVF cycles with good transfer results but no pregnancy. It is assumed that in these cases a hardening or thickening of the zona pellucida is the cause of the lack of implantation of the transferred embryos.

Blastocysts are embryos that have developed in the incubator for 5 days after follicle puncture and fertilisation and consist of 64 to 128 cells. Of all fertilised eggs, only about one-third develop into a blastocyst under culture conditions.
In a blastocyst transfer, the embryos are transferred into the uterus on the 4th or 5th day after the egg collection. Due to the longer culture period, the transfer takes place at the time when the embryos usually reach the uterus and implant.

Blastocyst culture is permitted in Germany. The transfer of fertilised oocytes can take place between day 1 and day 5 after oocyte collection. 24 hours after egg collection, the eggs in fertilisation (PN stages) are selected to remain in the cell culture.

In animal experiments, indications for a slightly increased risk of malformations were observed in prolonged cultures after the 3rd day.

The Arbeitsgemeinschaft Reproduktionsmedizin Nordrhein e.V. represents the interests of its members in all public, professional and scientific aspects of reproductive medicine. With the Arbeitsgemeinschaft Reproduktionsmedizin Nordrhein e.V. a competent contact person is available on behalf of most North Rhine-Westphalian reproductive medicine centres.

Further information

In women who have suffered multiple miscarriages, the uterine lining was examined in scientific studies for the presence of specific cells of the immune system. These cells are also detected in healthy women without miscarriages. There is a suspicion that too many of these cells could lead to problems with embryo implantation.

1. Uterine natural killer cells (UNK cells)

Basis:

Natural killer cells are a subgroup of white blood cells (leukocytes). Their task is to eliminate viruses, bacteria or tumour cells (hence "killer" cells). A distinction is made between peripheral (circulating) and uterine killer cells. In early pregnancy, the uterine killer cells regulate the interaction between the embryo and the maternal organism.

Theory:

There are indications that an increased number of UNK cells could have a negative effect on the implantation of the embryo. Therefore, patients with a so-called implantation failure (no pregnancy occurs despite multiple transfers of "good" embryos) or with repeated miscarriages could benefit from a determination of the UNK cells.

Such a determination takes place after tissue removal from the uterine lining as part of an endometrial biopsy (see also: endometrial biopsy).

Approach:

If an increased number is detected, it is possible to reduce it by lipid infusions. There is currently still a need for further studies in this area and a scientific discourse is being conducted.

 

2. Uterine plasma cells

Basis:

Plasma cells are a subgroup of white blood cells (leukocytes). They are used for the production and distribution of antibodies. An increased occurrence of these plasma cells in the lining of the uterus can be an indication of a chronic inflammation of the uterus (a so-called chronic endometritis). This inflammation is usually asymptomatic or with very mild symptoms.

Theory:

The inflammation leads to a change in the lining of the uterus, impairing the implantation or further development of the embryos. This can lead to a so-called implantation failure (no pregnancy occurs despite multiple transfers of "good" embryos) or repeated miscarriages.

The uterine plasma cells are determined after tissue removal from the uterine lining during an endometrial biopsy (see also: endometrial biopsy).

Approach:

Treatment with antibiotics attempts to eradicate the germs responsible for the inflammation. A new endometrial biopsy (see also: endometrial biopsy) is required to check the success of the treatment.

What is an endometrial biopsy?

Endometrial biopsy is the removal of a small amount of endometrium.

For this purpose, a small catheter or curette is inserted through the cervix into the uterine cavity and some tissue is obtained. This can be done during the consultation (anaesthesia is not necessary) or together with a uterine endoscopy.

The tissue obtained can then be examined in various ways (e.g. histologically; see also: endometrial plasma and NK cell determination, ERA test).

What is Endometrial Scratching?

Various studies have shown that slight scratching of the uterine lining (endometrial scratching) in the corpus luteum phase of the cycle preceding the stimulation or transfer cycle can significantly improve the chances of implantation.

How is endometrial scratching performed?

Between the 19th and 27th days of the cycle, a small amount of mucosa is extracted through the cervix using a thin disposable suction device (usually not painful).

The theory is that biopsy of the uterine lining causes a local inflammation-like reaction. This "inflammation" leads to an increased immigration of white blood cells and cells of the immune defence with presumably increased release of growth factors and cytokines, which are supposed to promote implantation.

What are the risks involved in implementation?

The possible risks and side effects of the method can be classified as low (inflammation, bleeding).

When should endometrial scratching be performed?

If two cycles of IVF or ICSI treatment have been performed without pregnancy, an inadequate endometrial receptivity may be suspected.

Patients with this so-called implantation failure could benefit from this method.

What does endometrial scratching cost?

Scratching is currently not recognised by the health insurance companies as a standard benefit!

Reimbursement by the appropriate bodies may not be guaranteed at all or not in full.

The cost including special catheter is 85,00€.

What is an ERA test?

Basis:

In the course of a female cycle, after ovulation under the influence of the female hormones, there is a (temporary) change in the lining of the uterus, which allows the embryo to implant itself. This time span is referred to as the "implantation window".

Theory:

Some patients do not become pregnant despite multiple transfers of good quality embryos (after artificial insemination) and despite comprehensive diagnostics having already been carried out. There are studies which suggest that in some of these cases the above-mentioned implantation window may be "displaced".

Approach:

The so-called receptivity (probability of implantation) can only be insufficiently assessed with classical examinations such as ultrasound or hormone determination, as well as histological examination after biopsy of the uterine lining. A determination of the genes responsible for receptivity appears to be a promising approach. For this examination a little uterine lining must be obtained and examined (see also: endometrial biopsy)..

This Endometrial Receptivity Array (ERA) allows the optimal time for embryo transfer to be more precisely defined.

In order to successfully carry out the subsequent embryo transfer under standardised conditions, both the ERA and the subsequent transfers are carried out analogously to the conditions of a cryo-cycle (build-up of the mucosa with oestrogens and conversion of the mucosa with progesterones, followed by a time-defined thawing and transfer of previously frozen fertilised ova or embryos).

However, further studies are needed to conclusively demonstrate the effectiveness of this method. A scientific discourse is currently still being conducted.

This serves to stimulate the ovaries within a monthly cycle to form several follicles in order to obtain several fertile eggs. This increases the probability of achieving egg cell fertilisation after intercourse or insemination. During IVF or ICSI treatment, up to three embryos may be transferred back into the uterine cavity (embryo transfer) in order to increase the chances of pregnancy. In order to achieve this, it is also advantageous to have as many fertilisable eggs as possible available for IVF or ICSI, as not all are usually fertilised. Any surplus fertilised eggs can be frozen (cryopreserved) for further transfers if desired.

This is the classic form of extracorporeal fertilisation, i.e. the fertilisation of eggs outside the body. After hormonal stimulation of the ovaries, the mature eggs are removed through the vagina shortly before ovulation and brought together in a culture vessel with the processed sperm cells of the husband in order to bring about fertilisation. After two to three days in the incubator, up to three fertilised, multiply divided eggs, which are already known as embryos, are transferred into the uterine cavity using a thin tube (catheter) (embryo transfer). IVF is performed when the woman's fallopian tubes are blocked or inoperable. But also the limited quality of the semen, endometriosis or unclear sterility in case of failure of other methods can be an indication for IVF.

Insemination is a simple, low-cost procedure in assisted reproductive medicine. The prerequisite for its performance is that at least one fallopian tube is intact. At the time of ovulation, sperm cells of the partner are isolated using special procedures and inserted into the uterine cavity using a thin tube (catheter). The sperm cells then only have to travel through the fallopian tubes to the egg(s), which increases the probability of egg fertilisation. Insemination is performed if, for example, the number and mobility of male sperm cells is limited or only a reduced proportion of normally shaped sperm cells is available.

The intracytoplasmic sperm injection (ICSI), a further development of IVF, differs from normal IVF in that the union of the retrieved eggs with the sperm cells of the spouse is performed under a special microscope. Here a single sperm cell is injected into an egg cell using a wafer-thin glass capillary. The other steps of ICSI treatment, such as hormonal ovarian stimulation or egg retrieval, are the same as for normal IVF. ICSI is mainly used when the number, mobility and external appearance of the sperm cells are very limited.

Sperm and testicular tissue

The freezing (cryopreservation) of sperm is particularly advisable when a pending treatment (e.g. chemotherapy for testicular tumours) is accompanied by a prolonged quantitative and qualitative impairment of sperm cell formation.

We carry out the cryopreservation of semen for long-term storage in the cryobank of Kryo Kindwunsch GmbH & Co. KG. The genetic material can be stored here for many years and retrieved if required for insemination, IVF or ICSI. In the context of sterility treatment, however, other reasons such as psychological impotence, illness or a prolonged absence of the partner may also make cryopreservation of semen necessary. The frozen sperm samples are stored in our practice for this purpose and can be thawed if necessary and used for the corresponding treatment procedures. Cryopreservation is of course also possible with sperm obtained by MESA (microsurgical epididymal sperm aspiration). The testicular tissue obtained during TESE (testicular sperm extraction) can also be stored deep-frozen. As a rule, several samples can be frozen at a time, allowing several ICSI cycles to be performed. Therefore, usually only a single surgical intervention is necessary. Testicular tissue samples can also be stored in the cryobank of Kryo Kindwunsch GmbH & Co. KG for many years.

Social freezing / Oocytebanking

The cryopreservation of early egg cell stages up to the mature egg cell (in an unfertilised state) was only possible with unsatisfactory success until more recently, as suitable freezing methods were not available. Thus it was not possible to ensure the fertility of women who had to deal with chemotherapy or radiation therapy and/or removal of the ovaries due to cancer.
However, the development and refinement of new freezing techniques (e.g. vitrification) has recently led to high survival and satisfactory fertilisation rates after cryopreservation was achieved, even with so-called metaphase II oocytes (mature unfertilised oocytes).
It is possible, after hormonal stimulation of the ovaries by means of a transvaginal follicle puncture, to obtain ova, freeze them and store them frozen for many years while maintaining their biological activity.

If a couple wish to have children, these eggs can be defrosted and fertilised extracorporeally. The resulting embryos are then transferred into the woman's uterus (embryo transfer).
DDepending on the protocol, stimulation of the ovaries takes about 14 days and in some cases delays the rapid start of oncological treatment. An alternative is in vitro maturation (IVM), which is based on the removal of very early egg stages (from the 5th to the 7th day of the cycle) from the ovaries, which are only stimulated for a short time. These early stages are first frozen, then, if necessary, later in the laboratory they are induced to mature further and, if necessary, fertilised. Cryopreservation of ovarian tissue is also very promising and in individual cases has already led to follicle formation, ice leaps and the birth of a child after autografting of the thawed tissue. Both in vitro maturation and ovarian tissue banking are methods that need to be further developed and may be available in the future as standard procedures.

Fertilised oocytes (PN stages)

Often, IVF or ICSI treatment results in several fertilised eggs. According to the German Embryo Protection Act, however, only three fertilised oocytes (pronucleated oocytes) may develop into embryos. However, it is possible to freeze the supernumerary pronuclear cells (cryopreservation). The deep-frozen pronuclear cells can be thawed in later cycles, grow into embryos and finally be transferred into the uterus. However, the chance of pregnancy is reduced compared to the transfer of "fresh" embryos. Cryopreservation of germ cells is recommended to maintain the fertility of tumour patients.
The treatment of tumour patients with chemotherapy or radiotherapy can cause temporary or even permanent infertility. For the affected patients, a later wish to have children can often only be fulfilled if egg cells or ovarian tissue are cryopreserved in good time before the tumour treatment. The cryopreserved samples can be stored for many years without loss of biological activity and can be used for fertility therapy if required.
In women, cryopreservation of surplus fertilised oocytes (pronucleus stages) resulting from artificial insemination treatment has been standard for many years. Thanks to improved freezing protocols, it is now possible to freeze mature eggs (metaphase II stages) and thaw them at a later stage in order to fertilise them for the purpose of transfer into the patient's uterus and thus fulfil her wish to have children. In the meantime, the pregnancy rates that can be achieved are quite within the range of the results achieved with freshly obtained ova.
Cryopreservation of ovarian tissue is also becoming increasingly important. Future findings must provide information on the optimal use of deep-frozen germ cell tissue. The following are currently the subject of intensive research:

  1. Autotransplantation, in which the patient's own thawed tissue is transplanted either in the abdominal cavity (orthotope) or in a specific part of the body under the skin (heterotope). The aim here is either to restart hormone production, to restore the ability to spontaneously conceive a child, or to allow follicles to mature for oocyte retrieval.
  2. Xenotransplantation, in which the thawed tissue is implanted into immunodeficient mice with the aim of allowing follicles to mature there in order to obtain oocytes.
  3. In vitro maturation, in which the thawed tissue is cultivated in the laboratory to obtain oocytes.

All three methods make it possible to obtain mature oocytes that can be fertilised using established standard methods of in vitro fertilisation. The resulting embryos can be transferred to the patient's uterus and eventually lead to the desired pregnancy.

It remains to be seen which of the methods described will ultimately prevail. Recent research results, however, give reason to hope that satisfactory treatment results can be achieved in the not too distant future.

In view of the fact that chemotherapy or radiotherapy can seriously endanger a woman's fertility, cryopreservation of ovarian tissue should already be recommended to a patient today, as it has been shown that promising treatment methods will soon be established and that the option of maintaining fertility through cryopreservation is only available once.

Long-term cryostorage of sperm/testicle tissue

For quite some time we have been cooperating with Kryo-Kindwunsch GmbH & Co. KG in the field of cold preservation of semen and testicular biopsies. Such a measure is necessary for patients who are at risk of temporary or even permanent infertility due to medically necessary tumour therapy (e.g. chemotherapy or radiotherapy). For those affected, mostly very young men, a later wish to have children can often only be fulfilled if sperm or, in the case of azoospermic patients with sufficient spermiogenesis, testicular biopsies are cold-preserved in good time before tumour treatment. The cold-preserved samples can be stored for many years and used for fertility therapy if required.

Patients who wish to preserve their genetic material in cold form should have a current spermiogram with the corresponding microbiological examination. If possible, patients should come to us at least two to three weeks before the upcoming tumour treatment. This leaves enough time to freeze the sperm of several ejaculates in order to have as large a reservoir as possible available for subsequent fertility treatment. Of course, we also offer this service to men who wish to undergo sterilisation.

Cryopreservation of testicular biopsies can also be arranged at short notice if the procedure is performed by yourself. Otherwise, we cooperate with experienced colleagues for this purpose. Please contact us in good time to arrange an appointment. We organise the transport of the sperm samples or testicular biopsies to Kryo-Kindwunsch GmbH & Co. KG.

The costs for the cold preservation of sperm or testicular tissue of tumour patients are covered by some health insurance companies. All health insurers decide on the assumption of costs in individual cases. It is therefore advisable to submit an informal application to the health insurance company for the assumption of costs in advance of a planned tumour therapy. Prices for cryopreservation on request.

If you have any questions please contact our IVF laboratory:
Dr. Al Azzeh
Tel.: 02161/49686-280

PICSI uses a special medium to which the "better" sperms adhere and uses it for ICSI. There are first studies that suggest better pregnancy success (Parmegiani et al. [2010a]"Physiologic ICSI" Hyaluronic acid [HA] favours selection of spermatozoa without DNA fragmentation and with normal nucleus, resulting in improvement of embryo quality. Fert. Sterile. 93.598-604).

The special medium is a natural alternative to conventional media because it consists of hyaluronate (HA), a naturally occurring substance in the cumulus complex; it has no toxic or immunological effects on sperm or oocytes.

Two main factors distinguish HA from other media:

  1. Increased safety aspect: HA is part of the oocyte's natural environment and fully biodegradable.
  2. Qualitative sperm selection: The SpermSlow selection procedure is based on sperm binding to HA using receptors on the sperm heads. Only mature spermatozoa bind effectively, therefore it is possible to select only the competent sperm with better developmental maturity and DNA integrity.

Evaluation: A scientifically sound proof is only possible after further clinical studies in the future.

When does PICSI make sense?

PICSI is recommended in the following situations:

  • Low follicular count
  • Women older than 38 years of age
  • AMH value of the woman < 0.5 ng/ml
  • 2 ICSI treatments performed without becoming pregnant
  • Presence of a significantly reduced sperm count (cryptozoospermia) in the spermiogram

Removal of the 1st and 2nd polar bodies (arrows) from the perivitelline space of a fertilised egg cell by biopsy.
Removal of the 1st and 2nd polar bodies (arrows) from the perivitelline space of a fertilised egg cell by biopsy.

Patient information on polar body diagnostics (PKD)

Chromosomal defects contribute significantly to the loss of embryos before and after implantation. Numerous studies have shown that the implantation failure of embryos, both after natural conception and after IVF or ICSI therapy as well as the occurrence of abortions in the first third of pregnancy, is largely due to spontaneous chromosomal defects. For IVF/ICSI treatment, the idea of excluding oocytes with possible chromosomal maldistributions from the fertilisation process by means of polar body diagnostics, and thus significantly increasing the proportion of transferred embryos with a normal set of chromosomes, is therefore obvious.

It is possible to carry out an additional examination of your oocytes as part of the IVF - or IVF /ICSI - treatment planned for you, which is known as polar body diagnostics. Such an examination can provide information about the quality of your eggs and improve the chances of success of your treatment.

Polar body diagnostics currently offers the only possibility for a chromosomal/genetic examination of unfertilised oocytes in compliance with the legal framework in Germany. The following information is intended to give you an overview of this specific diagnostic procedure and explain what it means for you if you decide to undergo this additional examination.

General Information

During its maturation, the egg cell must undergo two stages. A set of chromosomes that is initially present twice is distributed evenly between the egg cell and the first polar body at the first ripening division, which is then ejected into the perivitelline space, i.e. the area between the egg cell and the shell surrounding the egg cell (zona pellucida). The egg is then in a mature stage and ready to be fertilised by the penetration of a sperm cell. This is followed by the second ripening stage, in which each chromosome is split into two chromatids. The chromatids are now again evenly distributed to the egg cell and the second polar body, which is then also discharged.

Normally, the number of chromosomes in the oocytes and the corresponding polar bodies is the same. However, it is known that chromosomal distribution errors may occur during maturity division, leading to numerical chromosomal abnormalities (aneuploidies) in the affected oocytes. If such a chromosomal maldistribution occurs, then the number of chromosomes in the oocytes and in the associated polar bodies is unequal. Recent scientific studies have shown that oocytes from patients over 35 years of age have a chromosomal mismatch rate of over 50% (Pellestor et al., Hum Genet 112, 2003). This means that more than half of the eggs are unable to produce a healthy pregnancy from the outset. This is one of the reasons why the chances of pregnancy in women decrease with increasing age, while at the same time the risk of chromosomally caused miscarriages up to the birth of a child affected by a chromosomal disorder (e.g. Down syndrome) increases. Aneuploidies of chromosomes 13, 15, 16, 18, 21 and 22 (Wieacker et al., Reproductive Medicine 18, 2002) are particularly relevant here. These anomalies are mainly attributed to chromosomal aberrations that occur in the oocytes during the first maturation period (Abruzzo and Hassold, Environ Mol Mutagen 25, 1995).

Performing aneuploidy diagnostics on polar bodies

Both polar bodies can be removed from the egg cell by biopsy after opening the egg cell envelope using a special laser, which is harmless to the egg cell, and subjected to FISH analysis (fluorescence in situ hybridisation). With this examination method, the chromosome or chromatid sets in the polar bodies can be checked and conclusions drawn about the chromosome set remaining in the egg cell. Egg cells with chromosomal abnormalities can thus be identified.

This information is very valuable, as the maturation of the chromosomes can lead to misdistribution (aneuploidy). About 95% of all distribution errors occur with the first maturity division - i.e. with the formation of the first pole body - and only a few (about 5%) with the formation of the second pole body (second maturity division).

Embryos created from aneuploid oocytes often die before or shortly after implantation in the uterus. In some cases, however, this can result in pronounced undesirable developments. For example, mongolism (Down syndrome) is caused by the triple presence of chromosome 21.

80% of chromosomal defects in embryos are egg cell-related, while 20% are due to maldistribution in the sperm cells. The proportion of aneuploid mature eggs increases sharply in women after 35 years of age. In women over the age of 40, the proportion of these oocytes is already 50 to 70%. For these women, the chance of becoming pregnant and of having a pregnancy without complications is significantly reduced.

Polar body diagnostics (PKD) is an internationally established, successfully used diagnostic procedure for the prevention of the transfer of genetically non-intact embryos. The removal of the two polar bodies is harmless for the egg cell and its further development if it is carried out properly and takes place a few hours after the IVF or ICSI has been carried out. However, we would like to point out that it is not always possible to remove the second polar body, as it is often still firmly connected to the oocyte membrane and cannot be removed without damaging the oocyte.

The evaluation of the examination of the removed polar bodies takes place on the following day. In the laboratory, the genetically perfect eggs are then further cultivated for transfer.

The most statistically significant chromosomal aberrations are 13, 16, 18, 21 and 22. These are recorded in a routine FISH examination within the framework of PKD. Depending on the initial genetic situation of the pair, however, various other chromosomes can also be analysed.

Risks

Numerous studies in animal models and also in humans have shown that no damage to embryos resulting from biopsy oocytes was observed.

As mentioned above, FISH investigations usually only cover chromosomes 13, 16, 18, 21 and 22. Consequently, a misdistribution of the remaining chromosomes cannot be ruled out. If the second polar body cannot be removed for reasons already mentioned, there is a methodological residual risk of further undetected misalignments of approx. 5 %. Irrespective of how a pregnancy comes about, i.e. even if it occurs in a normal way, there is always a basic genetic risk of approx. 3 - 5 % for the occurrence of childhood malformations.

For this reason, we recommend that you have the various prenatal examinations such as ultrasound examinations, blood tests and, if necessary, genetic examinations such as an amniotic fluid analysis carried out despite carrying out polar body diagnostics in the event of pregnancy.

Aim of polar body diagnostics

  1. Avoiding the transfer of embryos with chromosomal maldistributions that do not lead to pregnancy or which, in the case of pregnancy, end in a miscarriage that may require scraping and can be associated with severe mental and physical pain.
  2. Prognosis for the further course of treatment. We know from international scientific experience that women who produce only eggs with chromosomal defects are very unlikely to produce healthy eggs in future treatment cycles. Although this insight is very bitter, it can nevertheless lead to the decision not to carry out any further treatment attempts and to incur costs that are disproportionate to the chances of a healthy child.

In our fertility centre we perform polar body analysis using the FISH technique in cooperation with the University Women's Hospital Bonn.

Expenses

The genetic diagnosis of oocytes is not covered by the statutory health insurance (GKV) and only occasionally by the private health insurance funds (PKV). Therefore, as a rule, this service cannot be provided at the expense of the health insurance funds. (For costs see current price list.)

Before carrying out polar body diagnostics, a consultation with one of the treating physicians is necessary. If you decide to have polar body diagnostics performed, you and the doctor must have signed a declaration of consent.

If there are no sperm cells in a man's sperm because, for example, the vas deferens are blocked or not present, it is possible to obtain fertile sperm cells from the epididymis. The sperm cells obtained in this microsurgical epididymal sperm aspiration (MESA) by puncturing the epididymis can then be used for microinjection (ICSI). Sperm cells isolated directly from testicular tissue (testicular sperm extraction, TESE) can also be used for microinjection (ICSI). Both the MESA and the TESE are carried out by us in cooperation with experienced urologists www.mariahilf.de . Both procedures require only very short surgical procedures.

[Translate to Englisch:] Das Embryoscope - Neueste Technik erhöht die Erfolgschancen der Kinderwunschbehandlung

The latest technology increases the chances of success of fertility treatment

At the beginning of pregnancy, the embryo implants into the lining of the uterus. It has always been one of the great challenges of fertility treatment to assess the implantability of an embryo. For many years, research here made little progress.

Therefore we are especially proud to present you with the "Embryoscope", a high-tech incubator with integrated camera, which takes us a long way forward in this respect.

Improve your chances of successful treatment

Normally, the embryologist must remove the trays containing the embryos from the incubator three or four times during the treatment in order to check the course of development under the microscope. This takes place at precisely defined times over three to five days and is always associated with a disturbance of the embryos. In order to keep the disturbance as short as possible, the biologist limits himself to the essentials, i.e. his assessment is based on a short "snapshot".
With the embryoscope, laboratory staff now have much better opportunities: the system consists of a state-of-the-art incubator, a built-in high-resolution camera, a special shell system that records the embryos, and intelligent embryo evaluation software.

How does the embryoscope work?

Using the built-in camera, the embryoscope continuously documents the development of the embryos by taking a picture of each embryo every 5-20 minutes. From this, the device creates a time-lapse film of the development of each individual embryo over two to five days. The embryos always remain in the optimal, stable culture environment of the incubator, and any disturbance caused by removal is eliminated. Highly developed software allows the biologist to estimate the implantation chances of each embryo better than ever before using the complete time-lapse images.

We at the Fertility Centre Niederrhein know more about your embryos

Complete information from the early embryonic development is very important for the evaluation of the development ability of an embryo. Many IVF centres do not yet have the possibility to obtain this information. We use the latest technology to improve your chances of pregnancy. The intelligent embryo scope software, developed on the basis of thousands of treatment cycles, helps us to evaluate your embryos. This allows us to ensure that the embryos we transfer to your uterus have the best possible developmental capacity.

Is the embryoscope eligible for my treatment?

The information gained from the embryoscope can have a positive effect on the success of the treatment. Scientific studies have shown that embryo evaluation using this new technique improves the pregnancy rate. This effect was noticeable even in older patients. In addition - and no less important - a reduced frequency of early abortions was detectable. The reduced risk of multiple pregnancy is also positive: the improved technique of embryo assessment can reduce the number of embryos while maintaining the same chance of success.

The time-lapse technique should be used in these particular cases:

  • extended culture/blastocyst culture
  • abnormal embryo development in pre-cycles
  • repeated implantation failure
  • repeated miscarriages (abortions)
     

Recommendations and assessments

Frauenärzte
in Mönchengladbach auf jameda
01/2018

Very good doctor

We were in treatment from February 2018 to March 2019 with Dr. Döhmen and his team. We found ourselves in very good hands there. The whole team is super friendly. [...] If Dr. Döhmen wasn't there, his replacement Dr. Bender took over, this doctor is also great. So we can only recommend. Result: 35th SSW with twins.

Rating from 30.09.2019

Very good doctor and great practice team!

After several consultations in various fertility centres, we felt that we were in very good hands with Dr. Döhmen. At no time did you feel like you were one of many. This has always disturbed us in the other centres. We spent a total of 7 months with him in treatment and got to know Dr. Bender during this time - just as recommendable. Our wish came true - many thanks to the whole practice team. We will recommend you to others.

Rating from 03.09.2019

Very competent and sensitive doctor

We were treated by Dr. Döhmen for about a year. We felt very well taken care of during the whole time. The entire staff is always friendly and they are all super super sweet there! Unfortunately, the 3 ICSIs were not successful, but this definitely had nothing to do with the treatment method, but was due to my egg yield. It was a very emotional time and the whole team was very hard working and sensitive. Thanks for that!

Rating from 05.08.2019

Highly recommended

A good practice works best in a great team, where doctors and employees work hand in hand. We felt very well looked after and in good hands. Without your professional skills and your necessary empathy, our wish might have remained a wish. We would like to thank you and your entire team for supporting us in fulfilling our dream.

Rating from 10.06.2019

A very competent, nice and experienced doctor

We were super satisfied, both with Dr. Döhmen and with the entire practice team. Very nice staff, always answered our questions well and in detail. Dr. Döhmen is a very nice, experienced and trustful doctor. He knows what he's doing and is very friendly with patients.

Rating from 03.04.2019

Successful fertility treatment

We were treated by Dr. Döhmen from August 2017 to August 2018. He's very straightforward, matter-of-fact and doesn't revolve around anything. You know immediately where you are and what the possibilities are. We personally welcomed the honest and direct way all professional and medical information was understandable. Team also always very dear and endeavoured. [...] We are now in the 32nd SSW and thus in the final spurt and would go again and again to Dr. Döhmen in the practice.

Rating from 04.02.2019

Satisfied all round

On the recommendation of friends we turned to the practice and were treated by Dr. Döhmen. We had an ICSI and we had immediate success with the first attempt. Our healthy daughter was born in December 2018. We felt well taken care of during the treatment and were very satisfied all around.

Rating from 24.01.2019

I will always recommend the practice!

The appointment allocation is quick. Also the discussions, investigations and the further procedure are on the point. The care is very compassionate. My husband and I have always felt this way. The practice is very well organised. We felt very well taken care of there!

Valuation from 06.01.2019

Very friendly and professional service

Whether Dr. Döhmen or the employees, they were always very obliging and very nice. With all my fears and questions I have always felt very well taken care of.

Rating from 24.12.2018

Great time

We have been made aware of this practice by my gynaecologist. During the six months of treatment we felt comfortable and understood our problem. We never felt like we were alone. All doctors and assistants were very happy about our pregnancy. Thanks for a great time!

Rating from 11.10.2018

Successful fertility treatment

Very nice and competent team. Success with first treatment.

Rating from 19.07.2018

Very experienced nice doctor

Top treatment, good experience. After the first time, it was possible to have twins.

Rating from 02.07.2018

Very professional and empathic practice team and excellent physician

I am a doctor and have been recommended the practice by a colleague. It was our third ICSI attempt after unsuccessful attempts outside. The support by Dr. Döhmen was excellent from the very first day, very professional and all our questions were answered. The support by Dr. Döhmen in the treatment cycle but also by the entire team was great and very positive so that we were also very positive. The puncture and embryo transfer were very relaxed and professional. I was doing very well the whole time, all questions were answered. We actually got the wonderful news to be pregnant with twins and I am now in the 13th SSW. I can wholeheartedly recommend the Döhmen/Schalkalk practice and wish all couples who wish to have children every success.

Rating from 09.06.2018

Very competent and friendly

Very good practice throughout. Very experienced doctor. All staff very friendly. You're in good hands here.

Rating from 03.06.2018

Competent and friendly

Competent and friendly, knows what he's doing.

Rating from 26.05.2018

Sensitive and competent

All processes in practice are very well organised. The medical care is absolutely professional, all employees are highly competent and safe in what they do. The personal approach by both the doctors and the practice staff is characterised by goodwill and an emphatic basic attitude.

Rating from 22.02.2018

Competent and very friendly medical specialist

[...] Dr. Döhmen is a trustful doctor who takes care of questions and radiates calm and patience. It is very reassuring to know that you are in good hands, especially when a woman has a long, previously unfulfilled desire to have a child.

Rating from 12.12.2017

Very competent and friendly team

We were in treatment for almost a year. The second cryo seems to have worked. The team was at all times very busy and always nice and friendly. Competence cannot be questioned. The successes speak for themselves. I would recommend this clinic to everyone and would be happy to come back if I wish to have more children.

Rating from 27.10.2017

The best doctor ever

Successfully released from practice. Thanks to God, Dr. Döhmen and the great team, I have been a mother for a year now. After six years of unsuccessful desire to have children, this practice and this doctor were my very last hope. I can't say enough thank you, Dr. Döhmen, and see you next time.

Rating from 08.06.2017

Friendly and competent

A good treatment already takes place in the anteroom, where you are warmly welcomed and stay in the waiting room without long waiting times. Doctor is friendly and competent. I felt very well treated at all times.

Rating from 16.01.2017

Very nice and competent

Nowadays you rarely see doctors who are so friendly/human with you as Dr. Döhmen! Thanks a lot for that!

Rating from 11.01.2017
Doctolib
Kalender
Appointment online