In Western Europe, 8-15% of all couples are affected by involuntary childlessness. By definition, this means an unwanted pregnancy after 12 months or longer.

Despite the duration, there is still a realistic chance of spontaneous pregnancy. With increasing age and increasing duration of involuntary childlessness, this probability decreases. In order to become pregnant afterwards, supportive measures are then necessary.

The fertility consultation takes place in the rooms of the Reproductive Medicine and Gynecological Endocrinology Department at Vogesenstrasse 134.

In order to avoid unnecessary clarifications, we ask you to bring copies of previous test results with you. If possible, ask your gynecologist for a summary of the examinations and treatments carried out so far.

In principle, the doctors in the fertility clinic see themselves as temporary substitutes for your gynecologist. Occasional telephone calls and regular correspondence ensure that you are kept informed about your current situation. If you are unsure, you can always get a second opinion.

The networking of the fertility clinic at the University Hospital also enables multidisciplinary care for special problems of involuntary childlessness. There is a regular professional exchange with specialists from other disciplines (medical genetics, endocrinology, urology, infectiology and specialists for tumor diseases, etc.).

Contact

Phone +41 61 265 93 37
E-mail: reproendo@usb.ch

Preimplantation genetic diagnosis is the genetic testing of embryos prior to transfer into the uterus for hereditary genetic changes or chromosomal abnormalities that could lead to impairments or diseases in the child.Preimplantation genetic diagnosis is only possible in the context of assisted reproduction (ICSI) with hormonal stimulation treatment.

In principle, a distinction is made between three different variants (PGT-M, PGT-A and PGT-SR), the application of which depends on the question posed by the respective genetic test.

PGT-M (PGT for monogenetic disorders)

In Switzerland, the revised Reproductive Medicine Act allows pre-implantation genetic diagnosis (PGT-M) to be carried out in families with known and genetically defined hereditary diseases. Only serious genetic diseases that cannot be treated in any other way or are unacceptable may be diagnosed, provided that the disease manifests itself by the age of 50 at the latest. Examples of such diseases are hereditary muscular dystrophies, cystic fibrosis (cystic fibrosis), Huntington's disease, BRCA mutation (breast cancer gene) and osteogenesis imperfecta.

PGT-SR (PGT for structural rearrangements)

This is a PGT for families who have a known hereditary chromosomal disorder. As a rule, one of the parents is a healthy carrier of a balanced translocation, which leads to a high risk of embryos with an unbalanced structural chromosomal disorder in the chromosome distribution in the germ cells. Such a chromosomal disorder then leads to a developmental disorder of the embryo and/or the fetus/child.

To prevent miscarriages and malformations, the same procedure can be used as for PGT-A.

PGT-A (PGT for aneuploidy)

In contrast to PGT-M and PGT-SR, which are used exclusively in families with a known genetically defined hereditary disease, PGT-A should be regarded more as a "reproductive medical measure". PGT-A is used to test the developmental capacity of embryos in the blastocyst stage and aims to exclude numerical or gross structural chromosomal abnormalities in the outer shell of the blastocyst. The possibility of carrying out a PGT-A is offered

• for couples with repeated miscarriages.
• in the case of repeated implantation failure in the course of assisted reproduction with embryo transfer.
• at the express request of couples undergoing IVF or ICSI therapy in order to assess the developmental capacity of the existing embryos more precisely.

Based on experience in the medical literature, pregnancy is achieved more quickly and unnecessary frustrating treatment loops are avoided, while miscarriages are significantly less frequent. as described above, pre-implantation genetic diagnosis is only possible in the context of artificial insemination (ICSI) with hormonal stimulation treatment.

In both of the above procedures, the eggs obtained are cultivated in the laboratory for five days after successful fertilization. Three to seven cells are then removed from the blastocyst stage embryos under the microscope using a biopsy needle from the outer shell of the blastocyst, which are used for further genetic testing. The biopsied blastocysts are initially not transferred but cryopreserved. Once the genetic testing has been completed a few weeks later and the genetic findings are available, individual, tested embryos are thawed and transferred into the uterus as part of a controlled, stimulated menstrual cycle.

If a couple is experiencing involuntary childlessness, both partners are examined for possible causes. In addition to examining the ejaculation of the man, the diagnosis also includes a confidential discussion with the doctor, a physical examination of the testicles with ultrasound and a blood test.

Spermiogram (ejaculate analysis)

The spermiogram plays a central role in the assessment of male fertility.

As part of the examination, the number, motility and shape of the sperm in the ejaculate are assessed. In addition to these classic parameters, additional characteristics can be determined, such as the extent of fragmentation of the genetic material in the nucleus of the sperm cells (DNA fragmentation).

Blood analysis

It is not uncommon for hormonal disorders to be responsible for impaired fertility in men. A blood sample is taken to determine the concentration of three sex hormones that can affect fertility. In an initial analysis, the concentrations of the hormones LH, FSH and testosterone are determined. If anything is unclear, further determinations may be necessary, which are determined in the same frozen sample.

The blood sample is always taken in the morning between 7 and 10 a.m. so that fluctuations in the concentration of these hormones during the day do not result in a misdiagnosis.

Detailed discussion

A detailed consultation is carried out to assess fertility and with a view to any fertility treatment that may be required. The aim of the consultation and examination is threefold

• To compare the results obtained in the laboratory with the patient's physical condition and health history.
• To clarify the causes of reduced fertility and treatment options for fertility.
• Confirmation of the man's point of view with regard to involuntary childlessness.

Physical examination

By assessing the male genital organs, conclusions can be drawn regarding the correspondence between the laboratory tests and the man's actual inability to conceive.

Attention is paid to the following special features: Testicular volume, presence of varicose veins next to the left testicle (varicocele), shape of the penis, especially the localization of the urethra, possible cysts in the scrotum or epididymis, and distance between the posterior attachment of the scrotum and the anus.

Genetic examinations

Occasionally, genetic examinations are also required. These include a chromosome analysis, also known as a "karyotype", a determination of possible microdeletions of the Y chromosome or a search for mutations in the CFTR gene.

Testicular biopsy (TESE)

If there is no or very little sperm in the ejaculate, tissue samples containing sperm cells can be taken from the testicles in collaboration with the urology department and used for fertility treatment. Tissue samples are taken from the testicles under general anesthesia.

Immediately after collection, the tissue samples are examined in the andrology laboratory for the presence of sperm and then frozen. One day before the planned egg retrieval, a sample is thawed and cultivated overnight. On the day of the puncture, the sperm cells removed from the testicular tissue can be used for the sperm injection.

Contact us

Phone: +41 61 265 93 63
Fax: +41 61 265 93 65

Availability: Monday-Friday 7.30-16.30

Menstruation is subject to hormonal control. So-called endocrine glands in the body release certain hormones at the right time.

Although the menstrual cycle is finely regulated hormonally, disorders often occur, each of which is accompanied by very different symptoms. In gynaecological endocrinology, we specialize in investigating hormonal disorders in women, diagnosing the causes of disorders and initiating suitable treatment.

Many cancers can now be cured using highly effective chemotherapeutic agents and radiotherapy. However, these therapies can have unfavorable effects on the function of the ovaries in women of reproductive age.

In order to enable affected patients to conceive their own child after surviving cancer treatment, there are various options for preserving fertility.

The choice of a suitable method depends on the timing of the start of chemotherapy or radiotherapy. Which method is suitable for you will be decided in close consultation with the oncologist treating you.

The patient's recovery always comes first. Our doctors will support you competently in this difficult situation.

Chemotherapy or radiation treatment can also have negative effects on the function of sperm production in the testicles of male patients. In order to maintain the possibility of reproduction after surviving cancer, the creation of a procreation reserve prior to cancer treatment is now standard therapy.

The procreation reserve is usually created by providing several semen samples, which are stored in cold, liquid nitrogen after preparation in our andrology laboratory. In certain cases, the collection and freezing of testicular tissue is also possible.

Together with your oncologist, our doctors will provide you with competent support in this difficult situation.

The number and quality of eggs decrease as women get older. Therefore, from a biological point of view, it would be easiest to get pregnant before the age of 30. However, at this point in time, life circumstances are often not yet right to fulfill the desire to have children. In order to offer women who are currently unable or unwilling to fulfill their desire to have children for private or professional reasons a flexible option for fulfilling their desire to have children, so-called "social freezing" has been established for several years.

This involves using hormonal stimulation treatment, similar to IVF treatment, to retrieve and freeze egg cells so that they can be used at a later date to fulfill the desire to have children.

Even if social freezing appears to be a promising alternative, there are a few points to consider. We therefore recommend that you make an appointment for a consultation with our experts if you are considering social freezing.

An unfulfilled desire to have children can mean a profound crisis for affected couples. Feelings of being overwhelmed, sadness, anxiety, shame and hopelessness can occur and also have a negative impact on the partnership.

In order to provide our patients with the best possible support in this difficult situation, our institute offers psychological care tailored to the individual needs of our patients in addition to medical treatment.

We accompany and support you in individual or couple discussions, both as part of a one-off assessment and in the event of a longer-term need for support.

Women in competitive and recreational sport place special demands on their health. Hormonal fluctuations, cycle changes, contraceptive issues, nutrition and bone health play a decisive role in performance, regeneration and well-being.

In our consultation hours, we offer advice and support specially tailored to female athletes - from puberty to the phase after an active career. This includes, among other things

• Cycle and hormone advice in the context of training and competition
• Holistic prevention of injuries that affect female athletes more than average or are related to the menstrual cycle
• Questions about contraception and family planning for female athletes
• Support with eating disorders, lack of energy and RED-S (Relative Energy Deficiency in Sport)
• Osteoporosis and bone health care

We offer specialized care and individual advice to help female athletes optimize their health, performance and well-being - for success in training and competition.