Diagnostics

Ovarian reserve us gives information about the egg supply, i.e. the number of eggs (oocytes) a woman has left in her ovaries. This is one of the basic indicators of a woman's fertility level, especially important if you are planning to postpone parenthood or if you are unable to conceive and are about to undergo one of the assisted reproduction methods.

The examination consists of two parts, detection of AMH levels (Anti-Müllerian hormone) in the blood and an assessment of the number of follicles on the ovaries using ultrasound - AFC (Antral Follicle Count). Follicles contain immature eggs and a higher number may indicate better ovarian reserve and vice versa. AMH levels correlate with the number of eggs in the ovaries as it is produced by the follicles. It gives us information about the amount of eggs that a woman can still release and is always interpreted with respect to the age of the patient. Its low level may indicate reduced ovarian reserve or premature menopause.

This is a standard gynaecological examination with an intravaginal (vaginal) or transabdominal (abdominal) probe. This examination has several applications during diagnosis and treatment. It detects:

• the presence of a dominant follicle in which the egg matures and thus confirmation of the presence of ovulation
• the height and structure of the mucosa (lining) of the uterus, which at the time of ovulation (egg release) should reach 8-12 mm
• number and development of follicles with eggs during hormonal stimulation
• deposition of organs in the small pelvis and position, size and shape of the uterus, the shape of the uterine cavity, the fit size and structure of the ovaries, the number of antral follicles (to determine the egg supply)
• Monitoring blood flow and the presence of a corpus luteum

Ultrasound examination of fallopian tube patency and uterine status is a non-invasive examination, which is normally performed on an outpatient basis without anaesthesia. It consists in the insertion of a thin catheter into the uterus, through which a contrast substance visible on ultrasound is injected. During the examination, the doctor can see whether the contrast medium passes through the fallopian tubes and reaches the ovarian region.

Uterine NK cells (from Natual Killer) are a special type of immune system cell normally found in the uterus. These cells play an important role in embryo implantation and placental development. Unlike the classic NK cells in the blood, which fight infections and tumors, uNK cells have more of a regulatory function - they support the nutrition of the embryo and control immune tolerance to the fetus. In addition, they also provide essential immune protection of the uterus against pathogens. Both their low and high numbers can lead to problems with embryo nesting.

This examination is is performed by endometrial biopsy (taking a portion of the uterine lining) at a specific stage of the menstrual cycle, and then the number and activity of NK cells are analysed and assessed. It is recommended in cases where:

• There have been repeated miscarriages
• There have been repeated implantation failures after IVF 
• In case of a history of pre-eclampsia or placental complications

 If excessive uNK cell activity is detected, appropriate therapy can be selected.

The test examines whether the endometrium is ready to accept the embryo at the right time. During the cycle, the lining of the uterus changes and there is a short period - called the window of implantationthat is most suitable for the embryo to nestle. In some women, this window may be delayed and occur earlier or later than expected. If the embryo is inserted at the wrong time, it may not attach, even if it is otherwise of good quality and healthy. The results will therefore tell us if the endometrium is:

• Receptive - the windows of implantation are in normal time.
• Non-receptive - the windows of implantation are shifted and the timing of embryo transfer needs to be individualized.  

This test is recommended in case of repeated embryo implantation failures in IVF, for women with a low or non-standard developing endometrium or for patients with a history of recurrent miscarriages.

It is about examination of sputum taken from from the cervix after unprotected intercourse. It is done at the time of ovulation, when the mucus has optimal properties for the penetration of sperm into the uterus. The mucus is examined immediately after collection under a microscope. Normally, moving sperm should be present in the mucus. The number of spermatozoa, their motility and the quality of their movement are evaluated.

From the results, we can see the ability of sperm to penetrate the cervical mucus and survive in this environment. The absence of moving sperm may indicate a problem either on the part of the partner (inappropriate composition of the mucus), on the part of the partner (inadequate sperm motility), but equally it may also indicate simply incorrect timing of the examination or an inadequate mucus sample.

The reason for the high percentage of immobile sperm may be, for example, the presence of antibodies against sperm that cause them to become immobile or clumped. Clumps are alive, but they prevent the sperm from moving and thus block the sperm's ability to fertilise the egg.