1. Initial conversation

Our aim is to show you the various options for infertility treatment during your initial consultation with one of our doctors. We will advise you about the causes of infertility, the various treatment options, their chances of success, possible risks and financial aspects. It is very important to us to provide you with individual care and advice.

If possible, you should make your first appointment with your partner, because fertility treatment is always a couple’s therapy. It is important that you take enough time; you should plan about one hour for the first appointment.

  • You should bring this with you to your appointment:

    • Referral slip from the gynaecologist (private patients do not need a referral slip).
    • Health insurance card of the woman
    • If available, findings of your gynaecologist (e.g. cancer screening, hormone values, surgery reports)
    • Completed questionnaire for the woman
    • Health insurance card (man)
    • if available, the findings of your treating urologist (man)

2. Diagnostics

After this initial consultation, a series of examinations will take place, starting with an appointment for blood sampling and ultrasound examination. The time for this depends on the day of your cycle. The 1st cycle day is the first day of your menstrual period.

An important hormone that should be at the beginning of all examinations is the anti-mullerian hormone (AMH): this can be used to directly measure the amount of eggs still present in the ovary. This is important both to give you an estimate of your chance of still getting pregnant and to determine how much hormone you will need. Unfortunately, the costs for this hormone determination are not paid for by the health insurance companies, but it makes medical sense.

Further necessary examinations may then take place. These include a physical examination, cycle diagnostics (ovulation), ejaculate analyses (spermiogram) of the partner, tube diagnostics (function of the fallopian tubes) as well as hormone and ultrasound examinations (clarification of egg maturation).

We may also refer you to our cooperating colleagues who will help you and us to find the cause: Human geneticists, coagulation specialists, urologists, andrologists, Chinese medicine doctors, nutritionists and our two psychologists.

3. Consultation and planning

After all examination results are available, a discussion appointment is held. In this discussion, the options for further therapy are presented and the medically appropriate therapy is recommended.

  • Possible therapies

    Hormonal stimulation & insemination (sperm transfer)

The stimulation of the ovaries begins from the 2nd to 3rd day of the cycle. A control examination by ultrasound then takes place again after 6 to 8 days. When the follicles have grown to an optimal size, a trigger injection with HCG (human chorionic gonadotropin) is given. 36 hours after this injection, ovulation usually takes place. If sexual intercourse is planned, it should take place 24-32 hours after the trigger injection.

In the case of insemination with the partner’s sperm or using foreign sperm, the same pre-treatment is carried out as with hormonal stimulation. 24-32 hours after the trigger injection, the partner delivers his semen to the Fertility Center Berlin. The preparation takes about 1.5 hours. This is followed by a normal gynaecological examination, during which the semen is introduced into the uterus using a small tube (intrauterine insemination).

The course of treatment is carried out according to the causes of infertility found.

IVF / ICSI treatment (in vitro fertilisation with or without microinjection (ICSI) of single sperm cells into the egg)

In the case of out-of-body artificial insemination, e.g. using the so-called long protocol, we start administering hormone-regulating medication between the 20th and 22nd day of the cycle (nasal spray or injection of the medication). The first examination then takes place 14 days later. Alternatively, stimulation can take place from the 2nd or 3rd day of the cycle as with hormonal stimulation.

After about 8 to 9 days, another check-up takes place. In order to be able to determine the optimal follicle size, blood samples and ultrasound appointments are arranged at intervals of 2 to 3 days. When the optimal size is reached, ovulation is induced between 8 – 24 pm. The follicle puncture (egg collection) takes place 2 days later. The fertilised eggs are then cultivated in the incubator for 2 – 5 days.

Since 2013, embryos can be observed with the embryoscope at the Fertility Center Berlin. The embryoscope is an incubator with a camera in which 9 pictures of the egg/embryo are taken every 15 minutes and thus the growth is continuously recorded in a time-lapse film. In standard cultivation, on the other hand, the oocytes and embryos may only be taken out of the incubator once a day for checking, so as not to impair the culture conditions and thus the ability to develop. Therefore, the embryologist only has a snapshot available to assess embryo development.

If an equal number of embryos is cultivated in accordance with the liberal interpretation of the Embryo Protection Act, we achieve an increase in the pregnancy rate of approx. 5-8 % per transfer by using the embryoscope, compared to cultivating the embryos in a standard incubator without a camera. This is in line with international data.

Thus, from 2013 – 2018, we achieved a pregnancy rate of 51 % after the return of two embryos in the embryoscope compared to 46 % in the standard incubator and of 42.9 % after the return of only one embryo cultivated in the embryoscope compared to 36.2 % in the standard incubator. The costs for the cultivation of the embryos are not covered by the health insurance and amount to 740 €. The embryo transfer into the woman’s uterine cavity can then take place on day 2 after the egg collection. The first pregnancy test: please do not take a test from your urine, as this could be falsified!

The result of the pregnancy test will be communicated to you by telephone by a doctor. If the result is positive, the test will be checked after 2 – 5 days, again by taking a blood sample.

However, the further course of the pregnancy cannot yet be predicted. If there is a good increase in the pregnancy hormone HCG, an ultrasound check is carried out after a further 14 days; if the pregnancy is intact, you will then be referred back to your gynaecologist for further prenatal care.

All treatment options at a glance

    The decision about the therapy will be made after the preliminary examination has been completed and a joint assessment has been made with your attending doctor. We make a rough distinction in the treatment options between fertilisation inside the body (hormone stimulation, intrauterine insemination) and those where fertilisation takes place outside the woman’s body (extracorporeal fertilisation, IVF / ICSI).

    Cycle monitoring and hormone stimulation treatments in women

    If the basic diagnosis has revealed an abnormality in the cycle, which disturbs egg maturation, ovulation and also the further course of the cycle, hormonal stimulation of the cycle can be the first therapy. The aim of hormone stimulation (clomiphene, FSH) is to optimise the development of an egg follicle.

    Under ultrasound and hormone controls, the development of the follicle is documented and ovulation is triggered. In this way, the optimal time for sexual intercourse is determined.

    Partner sperm treatment (homologous insemination)

    Intrauterine insemination (IUI) can be the appropriate method for achieving a pregnancy if there is slightly limited sperm quality and / or anatomical abnormalities in the woman. The pre-treatment in the woman can take place in the spontaneous cycle or also through hormone stimulation.

    After ovulation has been triggered, the time for the IUI is determined. The IUI procedure is similar to a gynaecological examination. You are allowed to get up immediately and can go about your daily life normally. The IUI can be carried out with sperm from your partner or with sperm from a third party.

    Fertilisation outside the body (in vitro fertilisation = IVF) and/or injection of the sperm into the eggs (intracytoplasmic sperm injection = ICSI).

    In vitro fertilisation may be the appropriate method for obtaining a pregnancy if the cause is an obstruction of the fallopian tubes, endometriosis or if there is a PCO syndrome in which pure stimulation does not lead to the goal or in the case of so-called idiopathic sterility, i.e. if the cause is unexplained.

    If the cause is in the man with more severely impaired sperm quality, the appropriate method for achieving pregnancy is fertilisation outside the body in combination with injection of the sperm into the egg (ICSI). The preparations for both IVF and ICSI treatment are the same.

    ICSI after sperm collection from the testis in cooperation with urologists (testicular sperm extraction, TESE)

    If there are no sperm at all in the ejaculate, it is possible to obtain sperm directly from the testicles (TESE = testicular sperm extraction) or epididymis (MESA = microsurgical epididymal sperm aspiration). This is carried out in cooperation with specialised andrologists.

    Foreign sperm treatment (donogenic insemination, donogenic IVF)

    The treatment of foreign sperm offers couples a treatment option if the partner has no sperm, e.g. congenital, after illnesses or treatments such as radiotherapy or chemotherapy. For homosexual couples and single women, the treatment with a foreign sperm source is a possibility to fulfil the desire to have a child.

    We will be happy to advise you on any questions you may have about the treatment of foreign sperm. We can also advise you on the choice of sperm banks. Legal advice and psychosocial counselling should be provided prior to donor sperm treatment.

    On 01.07.2018, the Sperm Donor Registry Act came into force. We are obliged to report the birth of a child conceived and born with donor sperm treatment to this register. The aim is to ensure that donor children know their biological origin. The health insurance funds do not cover the costs of the donor sperm banks. With donor sperm, both sperm transfer and fertilisation of the egg outside the body are possible.

    Embryoscope (possibility to continuously assess the development of fertilised eggs)

    The embryoscope is one of the newest and most advanced ways worldwide to continuously record the development of fertilised eggs (embryos). At the same time, the culture system allows the fertilised oocytes to develop under absolutely constant environmental conditions from the very beginning. Temperature, pH value and the supplied gas mixture of air and CO2 are kept in an optimal ratio for the egg cell.

    This creates culture conditions that are very close to the natural situation in the body. Here, as almost always in medicine, the principle applies: the closer something can be brought into line with natural conditions, the more optimal the success of the treatment can be.

    The built-in microscope allows continuous observation of cell development without having to remove the eggs. This is the only way to avoid disturbances that would otherwise have an unfavourable effect on egg development.

    Compared to the previous situation, there are thus more favourable conditions in suitable cases that can enable an improvement in the pregnancy rate. The results of our continuously conducted evaluations of the pregnancy rates of comparable treatments prove an increase, depending on the age group, of approx. 5 % to 10 % with cultivation in the embryoscope compared to standard cultivation.

    Late embryo transfer on day 5 or 6 (blastocyst transfer)

    Less than half of the fertilised eggs have the ability to develop into an embryo that can lead to pregnancy and birth. Many embryos die in the first two days in the incubator, so that they are no longer available for transfer to the uterus.

    However, if the fertilised eggs develop into good quality embryos, the woman will have a higher pregnancy rate if 1 (at most 2) embryo(s) is (are) transferred not on day 2 or 3, but at the blastocyst stage on day 5. However, this must be in accordance with the Embryo Protection Act in Germany, which prohibits storage fertilisation. However, it is possible, through careful monitoring of the oocytes, pronuclear stage cells and embryos, to allow women the option of blastocyst transfer without coming into conflict with the law.

    Our aim is to be able to carry out a transfer on day 5, because this is when the pregnancy rate is highest for you, especially in conjunction with the embryoscope.Of course, the cultivation to the blastocyst on day 5 or 6 with us is not associated with any additional costs for you.

    Freezing of fertilised oocytes in the pronuclear stage and of sperm (cryopreservation)

    In the course of fertility treatment by IVF or ICSI, more fertilised eggs are often produced in the so-called pronuclear stage (impregnated eggs). Since a maximum of 2 to 3 embryos should be created for return in a fresh IVF or ICSI attempt, surplus fertilised eggs in the pronuclear stage can be frozen (so-called cryopreservation).

    This option opens up additional embryo transfers, as the statutory health insurance funds usually only cover 3 attempts. If a supernumerary blastocyst is produced during cultivation into a blastocyst on day 5, this can also be cryopreserved. The vitrification method used in cryopreservation achieves a survival rate well above 95%.

    Cryopreserved pronuclear stages or embryos can be transferred back into the uterus in a later cycle without hormone stimulation. However, the statutory health insurance funds do not cover the costs of freezing, subsequent storage or the return cycle. The pregnancy rate at Fertility Center Berlin after transfer of thawed oocytes or embryos is just as high as in the fresh transfer cycle.

    Fertiprotection

    Fertility-preserving protection in women with cancer:

    Facing a malignant disease is an enormous burden for us. Fortunately, today the treatment options for malignant diseases have improved considerably, so that fertility preservation has a rightful place before starting treatment for a tumour disease.

    We will advise you on how and in what measures the tumour treatment can damage the ovaries and on the possibilities of fertility-preserving measures.

    After a short hormonal stimulation treatment, oocytes can be brought to maturation and these can be cryopreserved (deep-frozen) after retrieval. For couples with a fundamental desire to have children, it is also possible to fertilise the retrieved oocytes immediately and thus freeze the fertilised oocytes.

    The freezing of ovarian tissue during a laparoscopy is another option for fertility protection. This ovarian tissue can later be surgically replaced, so that a spontaneous pregnancy is quite possible.

    Fertility preservation in male cancer:

    In the course of cancer, chemotherapy or radiation can destroy the sperm-forming germ cells in a man’s testicles.

    Unfortunately, we are not allowed to freeze sperm cells in men with cancer, as in this case the health insurance companies do not cover the costs. However, the costs are covered by the health insurance companies if the freezing and storage is arranged by an andrologist. Please contact us in this regard:

     

    KBB Kryobank Berlin GmbH
    Dr. med. R. Andreeßen
    Reinickendorfer Straße 15, 13347 Berlin
    Tel.: 030 – 495 00 231
    Mail: info@krobank-berlin.de

    Charité Clinic for Urology – Cryobank
    Dr. Ina Wilkemeyer/Waldemar Geiger
    Seestraße 13, 13353 Berlin
    Phone: 030 – 450 615150
    Mail: andrologie-labor@charite.de

    andrologie-labor@charite.de

    Freezing of unfertilised eggs (so-called social freezing)

    Cryopreservation (deep freezing of unfertilised eggs and sperm) to preserve fertility has been a safe procedure for many years.

    Fertility preservation for women:

    The reasons why women and men choose this route, which is also called social freezing, are varied and are often due to personal circumstances and professional challenges, as well as the fact that fertility declines due to age.

    It is known that fertility decreases year by year in many women from the age of 35 onwards, and with it the likelihood that healthy eggs will mature.

    We take your wish to cryopreserve your unfertilised eggs very seriously. It is important for you to know in advance how well your ovaries can still respond to hormonal stimulation so that enough eggs can be obtained. Factors such as age, cycle, ovarian reserve and anti-mullerian hormone play an important role here. Since not every egg is vital and can be fertilised at a later date, and since not every fertilised egg develops into a healthy embryo, at least 15, preferably 20 eggs should be retrieved. Depending on the individual situation, several stimulation cycles are sometimes necessary. The retrieved eggs can be treated at a later stage in an extracorporeal insemination (ISCI).

    The costs for the treatment are not covered by health insurance and are around 4000 € including medication and anaesthesia. The costs for the later necessary extracorporeal fertilisation are also not covered by the health insurance. We will give you honest advice on whether social freezing makes sense for you and what opportunities this fertility-preserving measure can offer you.

    Fertility preservation measures for men

    Cryopreservation of sperm:

    It is possible to have your sperm cryopreserved with us. It is often necessary to make several appointments in order to be able to freeze a sufficient amount of sperm. The freezing and thawing process can possibly lead to a loss of sperm movement. Health insurance companies usually do not cover the costs of cryopreservation or storage.

    Counselling and treatment for chronic infectious diseases (hepatitis B,C, HIV) in connection with the desire to have children

    Chronic infectious diseases such as hepatitis B, hepatitis C and HIV can have an impact on one’s own health, but also on pregnancy and the child that is eventually born.

    At the beginning, the infectious disease and the previous therapy must be precisely recorded. Then, in most cases, a proposal for fertility treatment can be made.

    Assisted hatching (laser treatment of embryos)

    Incising the outer shell of the embryo, for example with a laser, to facilitate implantation of the embryo in the lining of the uterus.

    Polar body diagnostics (PKD), i.e. genetic testing of all 23 maternal chromosomes. This makes it possible to reduce miscarriages after IVF or ICSI (useful for women from the age of 38 and for couples with a tendency to miscarry).

    Polar body diagnostics is an examination method on oocytes that can be used to detect genetic disorders. In principle, it is possible to detect both genetic changes (hereditary diseases) and chromosomal changes (maldistributions and translocations) with this method. For certain groups of patients, the use of polar body diagnostics improves the probability of having a child (e.g. women over 38, couples with a tendency to miscarry).

    Surgical treatment of women with tubal obstruction (tubal sterility), fibroids, malformations of the uterus, cysts of the ovaries or endometriosis in close cooperation with the gynaecological clinic of the DRK Kliniken Westend on the same premises.

    We cooperate with the Department of Gynaecology in many areas, especially in the treatment of tubal occlusions, opening of fallopian tubes, removal of myomas and also especially in surgical treatments that become necessary in the case of endometriosis.

    In the case of endometriosis, a laparoscopy is usually unavoidable, especially as the chances of a spontaneous pregnancy increase significantly after the treatment of endometriosis. Our centre cooperates here with the endometriosis consultation of the DRK Clinic in Berlin.

    Acupuncture and Traditional Chinese Medicine in collaboration with Dr Diezmann-Wikowski Surgical treatment of women with tubal obstruction (tubal sterility), fibroids, malformations of the uterus, cysts of the ovaries or endometriosis in close cooperation with the gynaecological clinic of the DRK Kliniken Westend on the same premises.

    Accompanying acupuncture treatment and/or therapy with Chinese herbs can have a supportive effect during fertility treatment. Dr Sandra Diezmann-Wikowski, a specialist in anaesthesia with an additional qualification in acupuncture, is available to support you during fertility treatment.

    Fertility diagnostics in women

      • Hormone analyses
      • Ultrasound examinations
      • Examinations for inflammation of the genitals
      • Special examinations in women after frequent miscarriages (habitual abortions)
      • Ultrasound examination of the fallopian tubes with contrast medium (hysterosalpingocontrast sonography)
      • Examinations for genetic causes of infertility in women and men (chromosome analysis) in cooperation with Dr. Schell-Apacik

    Fertility diagnostics in men

      • Semen analysis (spermiogram)
      • Hormone analyses
      • Examination of the seminal fluid for inflammation and antibodies

    • Treatment costs

      To give you an idea of the costs for artificial insemination, among other things, that you will incur in each individual case, we list the individual items here and keep the data up to date.

      For couples with statutory health insurance:

      Since 01.01.2004, patients with statutory health insurance have had to pay their own share of the costs for reproductive measures. This entitlement to partial cost coverage for these measures by the statutory health insurance funds only exists for married couples. Both partners must have reached the age of 25; the entitlement ends for the woman when she reaches the age of 40 and for the man when he reaches the age of 50.

      Nowadays, legally insured infertility patients no longer have to pay a co-payment if they are in the right health insurance fund. This applies to married couples. The first statutory health insurance companies reimburse their patients for the co-payment, which can be up to 2000 euros per cycle, depending on the therapy (insemination, in vitro fertilisation or ICSI).

    We will show you approximately how much you should expect to pay:

      • Insemination without stimulation approx. 75 €.
      • Insemination with stimulation approx. 97 €.
      • In vitro fertilisation (IVF) with embryo transfer approx. 595 €.
      • Intracytoplasmic sperm injection (ICSI) with embryo transfer ca. 790 €
      • Anaesthesia costs approx. 150 €
      • Costs for the legally insured man approx. 18 €
      • Serology approx. 10 €
      • Preparation of the treatment plan approx. 4 €
      • In addition, there is the personal contribution for the medication: depending on the therapy, approx. 100 to 1000 € per attempt.
      • The final bill is issued at the end of the treatment.

    Private patients and self-payers receive an individual cost estimate depending on the therapy.
    If the person causing the infertility is privately insured, all costs of infertility treatment must be covered by the private insurance of the person causing the infertility. This is also the case if the other partner has statutory insurance. This also applies to unmarried couples and is valid for an unlimited number of attempts. We would be happy to inform you about the details in a personal conversation.

    Grants from the State of Berlin / State of Brandenburg

    Both the state of Berlin and the state of Brandenburg grant a subsidy for in vitro fertilisation or ICSI (intracytoplasmic sperm injection) after an application has been submitted. The Land of Berlin grants this subsidy from the 2nd attempt and also for unmarried couples. The state of Brandenburg grants this subsidy from the 1st attempt and also for unmarried couples in a stable partnership. Application forms for Berlin & application forms for Brandenburg

    For legal questions about your desire to have a child: cooperation with the Eberlein law firm

    Due to the new developments in the health care system, a certain uncertainty has arisen in some cases regarding the benefits for the desire to have a child, which are covered by the health insurance companies. In the event of difficulties or ambiguities, legal advice on your desire to have a child can be useful. We work together with the law firm Holger Eberlein. Legal advice is necessary for single women and same-sex couples when using donor sperm and can also be obtained from Mr Eberlein by telephone.