Diagnostics

Ovarian reserve provides us with information about the egg supply, i.e., the number of remaining eggs (oocytes) a woman has in her ovaries. It is one of the basic indicators of a woman’s fertility level, especially important if you are planning to postpone parenthood or are having difficulty conceiving and are preparing to undergo one of the assisted reproductive methods.

The examination consists of two parts: determining the level of AMH (Anti-Müllerian Hormone) in the blood and assessing the number of follicles in the ovaries using ultrasound – AFC (Antral Follicle Count). Follicles contain immature eggs, and a higher number of them may indicate a better ovarian reserve, and vice versa. AMH levels correlate with the number of eggs in the ovaries, as it is produced by the follicles. It provides us with information about the quantity of eggs a woman can still release and is always interpreted with regard to the patient’s age. A low level may indicate reduced ovarian reserve or premature menopause.

This is a standard gynecological examination performed with an intravaginal (vaginal) or transabdominal (abdominal) probe. This examination has several applications during diagnosis and treatment. We use it to determine:

• the presence of a dominant follicle in which an egg matures, and thus confirmation of ovulation
• the height and structure of the uterine lining (endometrium), which should reach 8-12 mm at the time of ovulation (egg release)
• the number and development of follicles with eggs during hormonal stimulation
• the position of organs in the small pelvis and the position, size, and shape of the uterus, the shape of the uterine cavity, the position, size, and structure of the ovaries, the number of antral follicles (to determine egg supply)
• Monitoring Blood Flow and the Presence of the Corpus Luteum

Ultrasound examination of fallopian tube patency and uterine condition is a non-invasive procedure typically performed on an outpatient basis without anesthesia. It involves inserting a thin catheter into the uterus, through which a contrast agent visible on ultrasound is administered. During the examination, the doctor observes whether the contrast agent passes through the fallopian tubes and reaches the ovarian area.

Uterine NK cells (from Natural Killer) are a special type of immune system cells commonly found in the uterus. These cells play an important role in embryo implantation and placental development. Unlike classical NK cells in the blood, which fight infections and tumor cells, uNK cells have more of a regulatory function – they support embryo nutrition and manage immune tolerance to the fetus. In addition, they also provide basic immune protection for the uterus against pathogens. Both low and high numbers of these cells can lead to problems with embryo implantation.

This examination is performed by endometrial biopsy (sampling a part of the uterine lining) during a specific phase of the menstrual cycle, and subsequently, the number and activity of NK cells are analyzed and evaluated. We recommend performing it in cases where:

• Recurrent miscarriages have occurred
• Recurrent implantation failures have occurred after IVF
• In case of a history of preeclampsia or placental complications

If excessive uNK cell activity is detected, appropriate therapy can be chosen.

The test examines whether the endometrium is ready to receive an embryo at the correct time. During the cycle, the uterine lining changes, and there is a short period – the so-called implantation window – which is most suitable for embryo implantation. For some women, this window may be shifted, occurring earlier or later than expected. If the embryo is transferred at the wrong time, it may not implant, even if it is otherwise healthy and of good quality. The results will therefore tell us whether the endometrium is:

• Receptive – the implantation windows are at the normal time.
• Non-receptive – the implantation windows are shifted, and embryo transfer needs to be timed individually.

This test is recommended in cases of repeated embryo implantation failures during IVF, for women with a thin or abnormally developing endometrium, or for patients with a history of recurrent miscarriages.

This is an examination of cervical mucus collected after unprotected sexual intercourse. It is performed at the time of ovulation when the mucus has optimal properties for sperm penetration into the uterus. The mucus is examined immediately after collection under a microscope. Under normal circumstances, motile sperm should be present in the mucus. The number of sperm, their motility, and the quality of their movement are evaluated.

From the results, we can see the ability of sperm to penetrate the cervical mucus and survive in this environment. The absence of motile sperm may indicate a problem either on the part of the female partner (unsuitable mucus composition), the male partner (inadequate sperm motility), or it may simply indicate incorrect timing of the examination or an insufficient mucus sample.

For example, a high percentage of immotile sperm may be caused by the presence of anti-sperm antibodies, which cause their immobilization or agglutination. Agglutinations are live but prevent sperm from moving, thereby blocking the sperm’s ability to fertilize an egg.