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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

Vážený pane doktore,
Užívala jsem asi 8 let antikoncepci(je mi 28 let), zpočátku pouze z důvodu nepravidelné menstruace. Po jejím vysazení-jsou tomu už 2 roky-se menses neobnovily.Vzhledem k tomu, že s manželem velice toužíme po dítěti, předepsal mi lékař Clomhexal (3.-7.den cyklu -1 tbl./den). 13.den cyklu byl na ultrazvuku patrný vždy pěkný 20-23mm velký folikul. Nic nenasvědčovalo rozvoji OHSS, přesto se však tento syndrom 2x vyvinul. (Na konci stimulace byl podán Pregnyl 5000j). Potíže začaly až kolem 18.dne cyklu. Po těchto neúspěšných pokusech byl vyšetřen i manžel.Výsledek spermiogramu vylučoval otěhotnění přirozenou cestou (nulový progresivní pohyb sp.) Byla jsem zařazena do programu IVF.Vzhledem k předešlému OHSS lékař začal velmi nízkými dávkami(50j.Puregonu/den),od 8.dne byla dávka zvýšena na 100j.a od 11.dne na 150j. Po celou dobu stimulace jsem si píchala i Decapeptyl 0,1.Vzhledem k pomalé stimulaci byl odběr vajíček naplánován na 16.den cyklu (předcházela inj. Pregnylu 5000j.-14.den cyklu) Ten 14.den cyklu byly na ultrazvuku patrné jen 2 větší folikuly (18 a 16 mm), zbylých 9 jen kolem 8mm. Po punkci mi lékař oznámil,že nebylo nalezeno žádné vajíčko, přestože kumulární bb.byly nalezeny. Nedovedu si vysvětlit důvod tohoto výsledku, i když vím,že ne každý folikul musí obsahovat oocyt.
Velice mne to vylekalo.V žádné mně dostupné literatuře jsem se o podobném problému nedočetla.
Je to jev častý? Můžete mi prosím doporučit literaturu, kde bych se o tomto dozvěděla? Jsem VŠ-zdravotnicky vzdělána.
Mám velké obavy, aby výsledek další stimulace(za 3 měsíce po 1.)nebyl stejný.Mohu já sama udělat něco pro dobrý výsledek?
Co je příčinou nevytvoření žádného vajíčka? Nemohly to způsobit nízké počáteční dávky FSH?(na 50j.Puregonu moje tělo nezareagovalo).
Jaký mohu očekávat další postup lékaře?
Moc Vás prosím o odpověď a předem Vám děkuji.

Správně píšete, že ne každý folikul musí obsahovat vajíčko. V malých folikulech to je poměrně časté, ve dvou normálně velikých mohlo jít o náhodu. Stane se, že i ve 20 folikulech nenajdeme ani jedno vajíčko. Není to časté, ale několikrát za rok se s touto situací setkáváme. Příčinu většinou neznáme, ze zkušenosti víme, že v dalším cyklu vše proběhne normálně. Důležitou roli hraje správná aplikace HCG, tedy ve Vašem případě Pregnylu. Obvykle též doporučujeme genetické vyšetření k vyloučení genetického bloku.
Nízká dávka FSH teoreticky vliv mít může, ale Vám doporučený typ stimulace – step up – se rovněž užívá a má dobré výsledky. Osobně bych při obavě z OHSS volil protokol s antagonisty, nikoli agonisty GnRh. Dávky FSH bych užil standardní. Věřím, že Vám Váš lékař tuto možnost nabídne.
Žádná literatura, v které by se tato atypie popisovala, mě právě nenapadá. Tyto situace jsou nejčastěji předmětem ústních sdělení v rámci odborných kongresů.
Sama pro dobrý výsledek dalšího cyklu nemůžete udělat nic konkrétního. Snažte se tím nestresovat, psychická pohoda je důležitá. Radím důvěřovat svému lékaři a dopředu s ním vše, především volbu stimulačního protokolu, probrat.
Přeji úspěch
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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