Infertility diagnostics and treatment

  • ERA tests
  • The ERA test helps avoid implantation failure by establishing the best day for embryo transfer. Learn more
  • Sperm tests
  • Spermogram
  • Method is based on the macroscopic and microscopic examination of sperm according to recommendations of the WHO. Macroscopically the colour, volume, liquefaction, consistence, pH level of the sperm is evaluated. Microscopically the concentration of spermatozoa, count of spermatozoa in ejaculate, motility, agglutination and morphology of sperm, as well as presence of other cells in the ejaculate is evaluated. Read more
  • Sperm oxidative stress test
  • Oxidative stress measurement demonstrates imbalance between the total activity of oxidants and total activity of reductant that can reduce the spontaneous pregnancy and fertilization potential.

    Standard if sORP value ≤1.38 mV/10⁶/mL (English: static Oxidation Reduction Potential).

    Free radicals affecting functionality of spermatozoids constantly are created in the body due to various metabolic reactions. Formation of free radicals is caused by stress, also various substances we regularly encounter in our daily life – tobacco, alcohol, household chemicals, heavy metals, UV radiation etc.

    All spermogram markers should be analyzed in total, considering also the age and general health condition of the patient. Doctor-urologist can provide interpretation of the spermogram data.

  • MAR test
  • MAR test determines antisperm antibodies on the surface of spermatozoids that is the immunological reaction of the body against its own spermatozoids. Antisperm antibodies limit the sperm mobility in the genital tract of a woman and affect sperm-egg fusion.

    MAR test is performed only on moving spermatozoids.

    Standard, if agglutination is observed for <50% spermatozoids.

    All spermogram markers should be analyzed in total, considering also the age and general health condition of the patient. Doctor-urologist can provide interpretation of the spermogram data.

  • HBA test
  • HBA test determines the ability of spermatozoid to bind with hyaluronan located in the cover of the egg; therefore it indirectly describes the ability of the spermatozoid to attach to the egg.

    Only completely mature spermatozoids with normal morphology and minimum DNA fragmentation can attach to the egg.

    Only moving spermatozoids are evaluated with the HBA test.

    Standard if the number of spermatozoids that are binding to hyaluronan is ≥65%.

    All spermogram markers should be analyzed in total, considering also the age and general health condition of the patient. Doctor-urologist can provide interpretation of the spermogram data.

  • DNA Fragmentation test
  • DNA fragmentation test is performed to determine structural damages of spermatozoid DNA that could delay implantation of embryo, increase risk of miscarriage, as well as facilitate hereditary pathologies for the progeny.

    DNA fragmentation test is used to evaluate the probability of spontaneous pregnancy and In vitro fertilization.

    Standard if spermatozoids with DNA fragmentation are <30%:

    • 15 - 30% good fertility potential
    • <15% very high fertility potential
    You can reduce DNA fragmentation by changing lifestyle, eating habits, quitting smoking and in separate cases also consuming more antioxidants.

    All spermogram markers should be analyzed in total, considering also the age and general health condition of the patient. Doctor-urologist can provide interpretation of the spermogram data.

  • Donor sperm
  • Option of artificial insemination in the event of untreatable male infertility. In order to have 100% security for donor sperm well-being, donor sperm is only used after careful double medical and laboratory investigations. All donors have been genetically tested – all are healthy and not registered with drug rehabilitation or psychiatric institutions. All the clinic's sperm bank donors are Latvian citizens. If you are using donor sperm, artificial insemination is performed using the IVF method.
  • Egg donor program
  • With the egg donor programme, Clinic EGV gives women an opportunity - who due to illness, surgery or other reasons cannot have a baby with their own eggs (for example, premature menopause or deterioration of eggs). This programme is also suitable for patients with serious hereditary illnesses, and patients unable to undergo genetic testing of the foetus for various reasons. Clinic EGV’s experienced specialists, the prerequisite equipment and procedures, and information about egg donors support successful pregnancies with the help of donor eggs.
  • Medicinal fertilization procedures
  • Our specialists are experts in all infertility treatment methods that require:

    • extensive knowledge
    • specially-trained staff
    • designated laboratory and medical equipment

    IUI (intrauterine insemination) – one of the simplest infertility treatment methods. This method is based on inserting sperm cells - which are first cleansed of needless cells - into the uterus. Insemination is performed around the time of ovulation, often with medical ovulation stimulation. Egg fertilization takes place in the uterine tube. IUI can be performed either with the husband’s sperm or donor sperm. Pregnancy after IUI with the husband’s sperm is expected in approximately 12% of cases, and 15% with donor sperm.

    IVF (in vitro fertilisation) – the standard method of insemination, whereby the egg is united with sperm cells that fertilise the egg under special conditions and in a supportive medium. A few days later, the resulting embryos are inserted into the uterus with a special catheter. See the FAQ section for more information about the procedure, process, and recommendations.

    ICSI (intracytoplasmic sperm injection) – fertilization is enabled by injecting the sperm cell directly into the egg. See the FAQ section for more information about the procedure, process, and recommendations.

    PICSI PICSI (Preselective Intracytoplasmic Sperm Injection) is a method used in conjunction with ICSI, which assists the selection of mature sperm cells for ovum fertilization. It has been proved that mature sperm cells can bind to hyaluronic acid in the egg shell. By adding hyaluronic acid to the medium, mature sperm cells become conjugate and inactive, which facilitates our embryologists’ work. Thereby the option also arises to select active, well-formed, healthy and viable sperm cells. PICSI significantly increases the chances of pregnancy and the number of qualitatively fertilized eggs and embryos.

    Blastocyst cultivation During the first fertilization, usually the embryo transfer into the uterine cavity occurs on the second or third day after fertilization when it reaches the stage of 2-4-8 cells. But after being transferred into a woman's body, it cannot be known whether the embryo continues its development. Yet by performing embryo transfer at the blastocyst stage (on the fifth-sixth day of development), i) there is confidence that the embryo is alive, and ii) it’s strength is known, i.e. natural selection has occurred. An embryo at the blastocyst stage is completely ready for binding to the uterus, and there is a much higher chance that this will happen. By helping the embryo grow to the blastocyst stage, we can choose embryos with higher implantation potential. During the natural fertilization process, if fertilization took place in the female uterine tube then the embryo reaches the uterine cavity at the blastocyst stage.

    This method is used:
    • if only one embryo is selected for embryo transfer
    • in the event of retreatment

    Assisted hatching The next day after the blastocyst stage (fifth day after fertilization) the embryonic shell should hatch and embryo development should continue. However, if the embryologist detects excessive thickness of embryonic shell or if there’s a need to increase likelihood of a positive result (i.e. at least one unsuccessful embryo transfer, blastocyst needs to be vitrified, embryos used after thawing, woman is over 37 years of age), assisted hatching can be performed with a special needle, laser or chemically. This process prepares the embryo for successful binding to the uterine wall and pregnancy.

    Embryo vitrification During the medical fertilization process, more embryos are developed than required - more than can be used the first time. As a fail-safe measure, should the first attempt not be successful then the embryos can be frozen. This quick-freeze method provides a much higher chance of embryo survival than slow freezing (which contributes to crystal formation in embryo cell cytoplasm). Only good quality embryos with the potential for future development are vitrified. So the embryo transfer can be repeated during the next cycle, avoiding the need to repeat the hormonal stimulation for the receipt of fertilized eggs. Latvian legislation allows for embryos to be stored for 10 years.

    Egg vitrification A method that facilitates storing young eggs for a longer time, e.g. to postpone family planning (a woman’s egg quantity and quality over 35 years of age decreases yearly, while chromosomal abnormalities increases) or in the event of an oncological disease that necessitates chemotherapy. Egg vitrification requires ovarian stimulation and puncture, and further storage.
  • Men's fertility diagnostics
  • After the first consultation with regards to infertility, potential causes of infertility, and treatment procedures, the physician will evaluate your medical record, perform a general examination, and prescribe a spermogram analysis of sperm quality. A more detailed examination may be necessary depending on these results.

    Before a spermogram is performed, the following measures should be adhered to:
    • Refrain from sexual activity for not less than two and not more than seven days
    • Refrain from alcohol, and preferably also smoking
    • Refrain from saunas or hot baths
    • Sperm sample should not be provided until two weeks after an antibiotic treatment or cold
    • Sperm sample is given in a designated room - with magazines and video provided. The man’s wife or sexual partner can also assist the process of course. The crucial aspect is for the WHOLE ejaculate to be collected in the container
  • Men's fertility operative treatment
  • Contemporary developments now allow men with no sperm cells in their ejaculate (azoospermia) to still become fathers. In this case, sperm cell aspiration from the testicles (TESA, testicular sperm aspiration) is performed. This is recommended in the event of:
    • very poor spermatogenesis
    • threat of spermatogenesis termination
  • Sperm bank
  • Sperm can be frozen for future use by using a sperm bank facility. This is an important service in the case of:
    • planned testis operation
    • planned vasectomy
    • radiotherapy or chemotherapy (in the case of oncologic illness)
    • cessation of spermatogenesis
    • work conditions that could negatively impact sperm cell formation
    • husband working abroad
  • women's fertility diagnostics
  • After the first infertility consultation, the physician will recommend the necessary examinations. Hormone levels are determined from blood samples and ultrasonography is performed on all patients. Additional tests and operative diagnostics/treatment are performed as required.

Women's reproductive health

  • Gynecological examination and consultation
  • Women of all ages should have informed knowledge about their health. Even in the case of no issues, proactive preclinical research will timely identify changes the symptoms of which only become apparent at a later stage of a disease.

Men's reproductive health

  • Urological consultations and examination
  • Urogenital system health (kidneys,bladder, urethra, prostate, testicles), as well as men's functionality and reproductive health. Clinic EGV’s urologists perform consultations and diagnostics, deliver treatment, and provide the very best professional advice.
  • Dopplerography examinations
  • Ultrasound of men’s genitals (including prostate, testicles and penis) and urinary tract ultrasound
  • TESA - testicular biopsy
  • For an azoospermia (lack of spermatozoids in sperm) diagnosis, several SRP (sperm retrieval procedures) can be performed. The simplest is testicular biopsy or TESA (testicular sperm aspiration) where a miniscule needle penetrates the testicle, and sperm (and small amount of testicular tissue) is aspirated out.
  • Micro TESE
  • In certain cases, spermatozoid levels in testicles can be so low that it takes place only at very specific points, which can’t be located before a biopsy. We then apply a special search technique - m-TESE - microsurgical TEsticular Sperm Extraction. The doctor opens the testicles though incision and uses a high-power operating microscope to locate seminiferous tubules that are swollen and may contain sperm. Such surgery can be useful for patients whose spermatozoids were not found during regular biopsy, or when before any spermatozoid examination treatment the doctor suspects little chance of finding them (e.g. reduced testicle size, various genetic problems).

    Any sperm retrieval treatment is performed in the surgery room under local or general anaesthesia - so is completely painless.

Longing for a baby...

  • Gynecological examination and consultations
  • Would you like to get pregnant soon? Then consult a gynaecologist to make sure you’re in tip-top shape and healthy. This will enable you to get pregnant quickly and easily, have the required strength for pregnancy and childbirth, and be fully prepared for this wonderful moment in your life. Make an appointment with our friendly gynaecologist-fertility specialist who will provide the best advice and support. Medical examinations will be proposed and performed as deemed necessary.

Expecting a baby...

  • Multiple pregnancy ultrasonography
  • Ultrasonography in the first trimester of pregnancy is crucial in the event of multiple pregnancy. During the first trimester, ultrasonography is generally performed via transvaginal access - this allows ovum visualisation as early as the 4-5th week of pregnancy.
  • Pregnancy - observation and consultation
  • During your pregnancy, we provide:
    • Your care in accordance with the governing principles of the Latvian Association of Gynecologists and Obstetricians
    • Ultrasonography in accordance with the new national standards of the appropriate healthcare practice
    • 1st trimester screening - 11-13th pregnancy weeks
    • 2nd trimester screening - 20-22nd pregnancy weeks
    • 3rd trimester screening - 34-36th pregnancy weeks
    • 3-D/4-D ultrasonography is sometimes necessary for additional examination (e.g. if a physician suspects congenital defect). Yet happily, prospective parents most often select this examination procedure for their own joyful record of the pregnancy. This type of ultrasonography complements data received from 2-D ultrasonography - presenting a fuller picture of the baby's gender and appearance. This first snapshot of the baby is a beautiful and touching memento for the loving parents. 3-D/4-D ultrasonography is only performed in the event of specific medical need.
    • Cardiotocography of the fetus is performed to more precisely evaluate the future baby's health. The fetus' heart tones can be measured and recorded with a specialized device from the 38th week.

Other services

  • Abdominal ultrasonography
  • The liver, gall bladder, pancreas, spleen, kidneys, large blood vessels and urinary bladder an also be examined, and in certain cases, enlarged lymph nodes can also be determined.

    Abdominal ultrasonography should be attended with an empty stomach - not having eaten for at least six hours. You can drink water and take any daily medication. A urinary bladder examination must be attended with a full bladder.
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Dana Leite
Fertility Treatment Coordinator (LV, RU, ENG)