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The Centre

of Reproductive Medicine 

& Gynaecology

20 years of tradition and more than 8,000 children

The Centre

of Reproductive Medicine 

& Gynaecology

20 years of tradition and more than 8,000 children

Question detail

Dobrý den,

vím, že u stimulovaných cyklů většinou dochází k insufienci žlutého tělíska, proto je potřeba doplnit v těhotenství hormony, které funkci žlutého tělíska doplní, tak, že žluté tělísko bude v těhotenství produkovat správné množství estrogenu a progesteronu, aby nenastal potrat.
Proto bych se ráda zeptala proč se liší KET oproti IUI či IVF.
Proč po KET je obvyklé užívat estrofem + utrogestan, zatímco po
stimulovaných cyklech jen utrogestan?
Prosím opravte mou úvahu: při KET žádné žluté tělísko nevznikne-žena neovuluje,takže je nutno dodat oba hormony. Po stimulovaném cyklu se díky ovulaci žluté tělísko vytvoří, ale většinou dochází k jeho insuficienci - tak se dodá progesteron, ale není díky insufienci žlutého tělíska produkováno i málo estrogenu?
Zajímá mě tedy, jestli po stimulovaném cyklu nevadí (může se) užívat i Estrofem (v jaké denní dávce), nebo je je to naopak špatné a jaké následky by jeho užívání způsobilo?
Velmi děkuji za odpověď.

Insuficience žlutého tělíska (=luteální insuficience) se projevuje především nedostatečnou produkcí progesteronu. Hladiny estrogenů bývají normální. Jiná situace je při anovulaci, kdy v druhé polovině cyklu prakticky kompletně chybí progesteron, relativně málo může být i estrogenů.
Problém luteální insuficience pak vždy není automaticky spojen se stimulací vaječníků. Odlišná je situace při stimulaci při léčbě anovulace, jinak je tomu při kontrolované hyperstimulaci v rámci IVF programu.
Vše komplikuje i obtížnost exaktního průkazu nedostatečné činnosti žlutého tělíska.
Nejčastěji se tento problém objevuje při léčbě anovulace u cyklů stimulovaných antiestrogeny (clomifen citrat). U cyklů, v kterých užíváme přímo gonadotropní hormony, nejsou výsledky zdaleka tak jednoznačné. V rámci kontrolované hyperstimulace při IVF programu vzniká žlutých tělísek obvykle více. Probléme pak je v tom, že jejich funkce může být narušena poškozením folikulů při odsátí vajíček. Estrogenů zde bývá nadbytek, hladiny progestoronu jsou obvykle též vysoké, může jich však být relativní nedostatek.
U KETu jde o to, zda je prováděn v nativním (tedy žádnými hormonálními léky neovlivňovaném) cyklu. Tento postup vyžaduje průkaz ovulace, obvykle opakovanou UZ folikulometrií. Je-li ovulace prokázána, je chybná hormonální produkce žlutého tělíska málo pravděpodobná. Estrogeny zde nepodáváme, progesteron (Utrogestan) přidáváme jen v relativně nízkých dávkách (2x100 mg denně). Na našem pracovišti takto transferujeme přibližně ¾ embryí v rámci kryoprogramu.
Alternativou je KET v cyklu s hormonální substitucí. Obvykle je pak předepisován estrogen již od počátku cyklu, po průkazu dostatečné výšky děložní sliznice přidáváme progesteron. V takovém cyklu chybí ovulace, proto ani nevzniká žluté tělísko a estrogeny i progesteron je třeba podávat ve vyšších dávkách až do doby, než hormonální saturaci gravidity zajistí placenta.
Ve výše uvedených řádcích snad najdete odpověď na většinu svých otázek. Pokud se týká té poslední, tedy užití Estrogenu u stimulovaného cyklu, je problém v tom, že přesně neuvádíte, co považujete za stimulovaný cyklus. Jde-li o IVF cyklus s kontrolovanou hyperstimulací, nemá tato medikace podle mých znalostí a zkušeností smysl. Hladiny estrogenů jsou díky mnohočetnému vzniku folikulů, a tudíž i žlutých tělísek (byť možná ne 100% fungujících), extrémně vysoké a vlastně bychom jen přilévali sklenku do vědra.
S pozdravem MUDr. Jan Šulc

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Your health and safety are our priorities

16.10.2020

Clinic is operating daily in accordance with epidemiology instructions in Czech Republic. Your health and safety are our priorities.   If you are travelling from abroad, we offer: - Official clinic invitation to confirm that travel is of medical purpose - FREE COVID PCR test for travel purposes for our female patients as part of their IVF treatment packages Feel free to contact us for more information.

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Annonymous spermiogram analysis

19.05.2020

The same as every year, this summer in June we offer “Annonymous spermiogram analysis”. You can book your sperm analysis using specific individual code according to which we wil track your result. The cost of the analysis is 1000 Kc.  Booking is possbile at the reception, by e-mail or phone.

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Easter opening hours

08.04.2020

Dear patients,  during Easter will be the clinic opened just for urgent cases on Saturday 11th and Monday 13th only in the morning. In urgency call +420 602  758 353. The clinic opens for you on Tuesday 14th April.  Thank you for understanding. We wish you happy Easter!

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Notice for patients: Coronavirus (COVID-19/ SARS-CoV-2)

11.03.2020

Dear patients and citizens seeking advice and assistance! As an assisted reproduction centre, even we are striving to protect our patients against potential coronavirus infection as best possible. At present, there is a prevalence of uncertainty, because a vast quantity of contradictory information is available in the media and on social networks. The “infodemic” - meaning the surplus of rumors, false reports and fake news - is minimally as problematic as the epidemic itself! For this reason, we strive to provide you with objective and up-to-date information on the topic of assisted reproduction, pregnancy and coronavirus disease, and to observe the recommendations of authorities and healthcare facilities. We ask you not to visit our assisted reproduction centre if you are suffering from symptoms suggesting coronavirus infection, or if you have spent time in any of the current high-risk areas in recent weeks, or have come into contact with potentially infected individuals. Currently, the high-risk areas are: Italy Iran In China: Province Hubei (inkl. City Wuhan) In South Korea: Province Gyeongsangbuk-do (Nord-Gyeongsang) Source: Robert-Koch-Institut (RKI): Status: 10th March 2020 At present, the health risk for citizens e.g .in Germany is classified as moderate. (Source: RKI: Status: 2 March 2020, 12:30 p.m.). Contagion from person to person is the gravest means of infection. In general, the same preventive, protective and hygienic measures as those applicable during ordinary flu season should be observed. This includes proper hand hygiene, not shaking hands when greeting and keeping a distance from individuals who are ill - including people with cold or flu symptoms.(https://www.infektionsschutz.de/coronavirus-sars-cov-2.html). COVID-19 infection is generally mild, sometimes entirely asymptomatic. The level of danger of the pathogen cannot yet be reliably assessed - but it seems to be substantially lower than in the case of MERS or SARS, and is likely to be comparable to the seasonal flu (source: AGES, status: 3 March 2020, https://www.ages.at/themen/krankheitserreger/coronavirus/). In some cases, the course of the illness can be severe. The illness tends to be fatal primarily among the elderly and/or individuals with a severe chronic health anamnesis. At present, there is no reason to believe that COVID-19/ SARS-CoV-2 infection would have a more severe progression among pregnant women than women who are not pregnant. Likewise, no cases of transmission of the virus to an unborn child have been described or confirmed yet (status: 2 March 2020). In addition to the usual preventive measures, we recommend that patients who wish to get pregnant be vaccinated against the flu, not least to avoid concurrent infection with COVID-19/ SARS-CoV-2 and the flu. This applies both to unvaccinated pregnant women and unvaccinated women who wish to get pregnant. Vaccination against the flu virus poses no threat to pregnant women, and does not require the postponement of pregnancy therapy, because it is a “dead vaccine”. Therefore, pregnancy is not a contraindication to flu vaccination. Although the 2019/2020 flu season has most likely already peaked, you should get a flu vaccination even now. In fact, vaccination against the flu is explicitly recommended for pregnant women. The Standing Committee on Vaccination in Germany (STIKO) recommends flu vaccination for all pregnant women from the 2nd trimester; if there is a higher health risk due to other medical problems (e.g. asthma or diabetes), from the 1st trimester of pregnancy.

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Client ranking

Beautiful

Beautiful "Thank you" from a happy, new mother
15.04.2020

Even during COVID pandemic time babies are born, including via IVF treatments. We received this beautiful thank you message from a happy new mother.

"I wish you primarily good health, so you could handle this challenging times and continue with your work. You have helped us greatly and we will be forever grateful."

Thank you

Thank you
04.03.2020

Dr. Šulc,

we would like to use this opportunity to thank you and your colleagues for the  care we received during our IVF treatment and following pregnancy from May 2019 until now.

We are especially grateful for your personal approach to our case, we felt cared after even when situation was not easy, we always knew we can turn to you for advice. We are aware that today it is unfortunatelly not a standard everywhere, so we value not only your medical help but also kind approach.

Michalka

Michalka
26.02.2020

Finaly even me can boast with joyfull news. On 10th February 2020 was born gorgeous girl Michalka (3650 g, 51 cm). She arrived 10 days after predicted date of birth. We, happy parents, want to thank to the whole Gest team for the longwished happiness. Markéta and Lukáš

Michal

Michal
07.01.2020

Finally can we show off our babyboy Michal. He was born on 24.12.2019, his weight was 2720g and was 48 cm long. Michal came into this world little bit earlier - at 37th week. 
Thanks a lot to the whole team - finally we have our little treasure. 
Happy parents Jaroslava and Luboš 

Zuzanka

Zuzanka
11.12.2019

We would like to thank the whole GEST team for the birth of our babygirl Zuzanka. She was born on 13. 7. 2018. Her weight was just 1120g - she was early born (28+6 week). She became a healthy, beautifull girl.
Grretings and thanks a lot again. 
Milena Wágnerová  

 

Jakoubek

Jakoubek
25.11.2019

We would like to thank to the whole GEST team for their care, namely Dr. Šulc, his colleagues, which we also met - Dr. Poláková, Dr. Černý and Dr. Alexandr. 
On 28th October was born our healthy babyboy Jakoubek. 
Thank you very much!
Jana and Martin 

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ProCrea Swiss IVF Center s.r.o.
Nádražní Str. 762/32
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150 00 Praha 5 - Smíchov

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Phone.: +420 257 212 516 - 518
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