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Medications used during the sterility treatment and methods of assisted reproduction

Oestrogens and progestogens are the main female sex hormones. They are commonly produced in the ovaries. Oestrogens are formed throughout the entire cycle, progestogens only in the second half of the cycle, after ovulation. Their main role is to work together to prepare the endometrium for implantation of the embryo.

In the field of assisted reproduction, in some cases the combination of oestrogens and progestogens is used to prepare the endometrium before the transfer of frozen embryos (FET). Progestogens alone are sometimes used after ovulation to support the preparation of the endometrium for embryo implantation or in the early stages of pregnancy, but also later in pregnancy to prevent premature delivery. However, it is always used in IVF cycle after egg retrieval to ensure the quality of the endometrium. We prefer agents with the effect as close to the natural hormones as possible.

Oestrogens may be in the form of tablets (Estrofem, Pogynova, Estradiol, Estrace) adhesive plaster, spray or gel. Progestogens are administered orally; vaginal administration (Utrogestan, Gynprodyl, Crinone, Lutinus), or intramuscular (Agolutin) or subcutaneous (Prolutex) injections are more advantageous.

Ovulation in infertility treatment is often induced by antiestrogens (Clostilbegyt tbl, Tamoxifen tbl.). Their functioning is based on making use of feedback between oestrogens and gonadotropic hormones. Antiestrogens bind to oestrogen receptors and thereby induce production of gonadotropic hormones. They are always administered for a few days in the first half of the cycle.

Gonadotropin

To stimulate ovulation we use gonadotrophin hormones (gonadotrophins, GTH). They are formed naturally in the pituitary gland (hypophysis) and regulate the ovarian activity. GTH include the follicle-stimulating hormone (FSH) whose task is the growth of follicles, and luteinizing hormone (LH)whose task is maturation of follicles and induction of ovulation. Human chorionic gonadotrophin (HCG) is produced only during pregnancy by trophoblast and later by placenta. Detection of this hormone in blood or urine is used as a pregnancy test. For its structural similarity to LH it is used and produced, among other things, to trigger (start) ovulation (Pregnyl inj., Ovitrelle inj.).


We distinguish medications with only FSH effect, with only LH effect and with combined FSH + LH effect. Both types of products are used. Opinions on whether or when to use the product with a combined effect are not uniform. According to the method of production we distinguish the urinary-derived products, highly purified urinary-derived products and recombinant products.

The urinary-derived medicinal products have been on the market for the longest time, they always contain a certain amount of impurities and their effects are not completely constant (Menopur amp., Eigenorm amp.).

Recombinant medicinal products are newer; they are produced by genetic engineering. They do not contain any impurities and the active substance content varies less than in urinary preparations. (Puregon Pen, Elonva inj., Gonal F Pen, Bemfola inj., Ovaleap Pen, Pergoveris Pen).

All gonadotrophin stimulation medications are applied subcutaneously by a thin needle and are therefore intended for self-administration. Most patients can do it without problems.

We use either small doses of gonadotrophins to induce maturation 1 or 2 follicles followed by IUI, or higher doses for controlled ovarian stimulation before IVF. We want to obtain more than one egg and consequently more than one embryo. This is achieved by administering gonadotrophins in relatively high doses. The dose depends on the results of hormonal profile, age, type of protocol, or weight, as the case may be.

In controlled hyperstimulation, it is not convenient that such substances are formed naturally in the woman’s body simultaneously with the administration of gonadotrophins. The thing is that it would be very difficult to harmonize their common action.

Therefore, in all ovarian stimulation protocols we use medicines that block the natural release of gonadotrophins from the hypophysis. They are called GnRh analogues. Under normal circumstances, the gonadotrophin releasing hormone (GnRh) is created in the part of brain called a hypothalamus. In the treatment, we do not use directly GnRh, but the substances originating from certain modifications of its molecule. We divide them into agonists and antagonists.

Shortly after their administration, agonists (Diphereline inj., Decapeptyl inj., Synarel spray) have the same effect as GnRH, and thus they increase the release of gonadotrophins from the pituitary gland, but later, thanks to their strong bonding, they block the pituitary receptors and inhibit the release of gonadotrophins. For this reason, agonists should be administered in the long term to make use of their blocking effect.

Antagonists (Cetrotide inj., Orgalutran inj.) have only a blocking effect; they can be therefore administered in the short term, during the stimulation itself.

Notice:

There are certainly not all the preparations listed in our list. The reason for this is the fact that the situation in our market is constantly changing. The list will be continually updated.

News

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
(entrance from Rozkošného Str. 1058/3)
150 00 Praha 5 - Smíchov

Surgery hours:

Monday 8:00 - 16:30
Tuesday 8:00 - 19:00
Wednesday 8:00 - 19:00
Thursday 8:00 - 16:30
Friday 8:00 - 16:30
Saturday Emergency only

Contact

Phone.: +420 257 212 516 - 518
Mobile: +420 602 328 346
E-mail: info@gest.cz
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