Treatment for the wish to have a child

Polar Body Analysis
Chromosome translocation is the most common cause for loss
of embryos before and after implantation. Many scientific studies
show that spontaneous chromosome translocation is responsible
in a large part for the failure of implantation of embryos after an
IVF/ICSI therapy, as well as the occurrence of miscarriages in the
first trimester of a pregnancy. It is therefore advisable in case of an
IVF/ICSI treatment to exclude egg cells with chromosome
translocations from being fertilised by applying polar body analysis,
and thus increasing the amount of transferred embryos possessing
a normal chromosome set.

It is possible to carry out a polar body analysis during an IVF
or IVF-ICSI treatment. This examination may provide information
on the quality of your egg cells and may improve the chances for
a successful treatment.

Polar body analysis is at the present time the only possibility for
carrying out an examination of chromosomes of unfertilised egg cells
within legal limitations. The following pieces of information are to help
you gain an overview on this special method of analysis, and what will
be implied for you if you decide to have this additional examination.

General Information
When an egg cell is ripe, its double chromosome set will be reduced
to a single chromosome set through a first meiosis. One set of
chromosomes remains in the egg cell, while the second set of
chromosomes is discharged by forming the 1st polar body. After a
sperm has entered the egg cell, the 2nd meiosis sets in, dividing
every chromosome into two chromatides. One set of chromatides
remains in the egg cell, whereas the 2nd set of chromatides is
discharged by forming the 2nd polar body. Normally, the number
of chromosomes in the egg cells and in the respective polar bodies
is same. It is acknowledged, however, that mistakes in
chromosomal allocation may occur, which lead to anomalies in
the number of chromosomes (Aneuploids) in the respective egg
cells concerned. If such a chromosome translocation occurs, the
number of chromosomes in the egg cells and in the respective
polar bodies differs.

Recent scientific research has found egg cells of patients that are
older than 35 years to show a rate of chromosome translocation of
over 50%.
(Pellestor et al., Hum. Genet., 112, 2003).
This means that over half of the egg cells are not capable from the
outset to lead to a healthy pregnancy.

This is one of the reasons why with the increasing age of women the
chance for the occurrence of a pregnancy decreases, with a
simultaneously increasing risk of miscarriages due to chromosome
disorders, or even of the birth of a child suffering from a chromosomal disorder (e.g. Down Syndrome or Trisomy 21).
The aneuploidies (translocations) of chromosomes
13, 15, 16, 18, 21, and 22 are especially relevant
(Wieacker et al., Reproduktionsmedizin, 18, 2002).
These anomalies are mainly ascribed to chromosomal
translocations happening in the egg cells during the 1st meiosis.
(Abruzzo und Hassold, Environ. Mol. Mutagen., 25, 1995).

Carrying out an Analysis of Aneuploidies with polar bodies
In principle, polar body analysis shows the genetic stat of the egg cell
by carrying out a cytogenetic analysis of the polar bodies. This aims at identifying chromosomally disturbed egg cells in order to exclude them
from the further fertilization process. The extraction of the polar bodies
(polar body biopsy) necessary for this examination is done 2-3 hours
after the ICSI has been carried out by opening up the egg cell wall by
means of a laser. These polar bodies are then used to produce
microscopical preparations, and several chromosomes will be
made visible by a special dyeing method, the so-called Fluorescence
In Situ Hybridyzation (in short: FISH).

In this way, the number of special chromosomes in the polar bodies
can be determined, allowing a conclusion about the chromosome
set of the belonging egg cells. If the polar body shows a copy of a
certain chromosome, it can be assumed that there is a copy in the
belonging egg cell. This is normally the case. If the preparations
made from the polar bodies do not show a copy of a certain
chromosome, it can be assumed that the belonging egg cell will
contain one copy too many and that thus a chromosome dislocation
will have taken place. Further culturing of such an egg cell is
therefore not advisable.

Polar body biopsy with an ensuing FISH analysis is an
internationally recognized method which is successfully used for
diagnostics of chromosomal dislocations.
(Munné et al., Prenat. Diagn. 20, 2000).



According to current knowledge, a damage to the egg cell inferred
by this examination can be excluded. The extraction of the second
polar body cannot always be guaranteed, as it is still closely attached
to the egg cell at the time of the biopsy, and a forceful extraction would
lead to damage to the egg cell. In this case, the examination would
only be carried out using the first polar body. We offer to find out the
allocation of the chromosomes 13, 16, 18 and 22 in your egg cells
by applying the FISH analysis after extraction of the polar bodies.
Naturally you will be informed on the results of the examination in
the course of your treatment.





Consultation
A consultation with one of the physicians involved is necessary before
polar body analysis is carried out. Should you wish to have this
additional examination, we ask you to sign the attached declaration of consent, which will then be countersigned by the physician.

Recommendations
A limitation of the polar body analysis lies in the fact that only those chromosomal anomalies may be detected that are inherited from the
mother. Chromosomal anomalies inherited from the father cannot be
detected by using this method. As FISH analyses are carried out on
single cells with the polar body analysis, a statistical safeguard of the
results is not possible. Wrong-positive and wrong-negative results
cannot be completely excluded. In case of a pregnancy we recommend
that you make use of the various possibilities of prenatal diagnostics
aside from polar body analysis. Our examinations within polar body
analysis include only the chromosomes 13, 16, 18, 21, and 22.
Translocations of other chromosomes may therefore not be excluded.
Also, there is a 5% chance of a remaining risk for a numeric anomaly
of the chromosomes examined if the second polar body has not been examined.

In case of a pregnancy prenatal examinations such as sonography,
blood tests and genetic analyses of chorionic villi and amniotic fluid
make it possible to detect major malformations of the child or genetic disorders. Should you have any further questions about this subject,
we recommend you seek specialised advice on human genetic.

Aims of Polar Body Analysis
1) Avoiding the transfer of embryos with chromosome translocations,
which cannot lead to a pregnancy or, in case of a pregnancy, would
lead to a miscarriage entailing a curettage connected with great psychological and physical pains.

2) Compilation of a prognosis for treatment. From the experience of international science we know that women who only produce egg
cellswith chromosome translocations will most probably not produce
healthy egg cells in further treatment cycles. Acknowledging this
may be very bitter, but it can lead to the decision not to try for further
treatment and thus be spared the burden and costs that are in no
relation to the chances of getting a healthy child. Please contact
us for further information.

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This is how we proceed

First Consultation and Anamnesis
During our first meeting, we will talk extensively about more...

Menstrual Cycle Analysis and Surveillance
At the beginning of each individually adapted therapy we will
thoroughly more...

Spermiogram and Andrological Examination
Also at the beginning of the therapy, the male seminal fluid more...

Discussion of Results
After the first results are available more...

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Methods of Treatment

Testing of Fallopian Tubes by Ultrasound
Assessing tubal patency by using imaging contrast agents more...

Hysteroscopy
Hysteroscopy is very important in assessing the interior more...

Laparoscopy
Laparoscopy is the most precise method in assessing the
fallopian tubes more...

Stimulation of Ovaries
In order to stimulate the ovaries, we will use hormones more...

In Vitro Fertilization / Embryo Transfer
Since 1978, in vitro fertilization has opened up a therapeutic
possibility more...

Sperm Microinjection (ICSI)
Sperm microinjection is the direct injection of a sperm more...

TESE, MESA
TESE is the Testicular Sperm Extraction more...

Cryopreservation of Sperms and Fertilized Eggs, Cryo-TESE
If required, sperms can be frozen more...

How we take care of High-Risk Pregnancies during the first three months
After fertilization outside the body, it is often necessary to support the pregnancy more...

Acupuncture
The use of acupuncture may be neurophysiologically indicated more...

Diagnostics of Trace Elements and Harmful Substances
Diagnostics of trace elements and harmful substances represent
an important factor more...

Gynaecological Endocrinology
Gynaecological endocrinology is mainly concerned with more...

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What You Can Do

Qigong
In addition to medical therapy, we offer a complementary Qigong
class more...

A Healthy Diet/ Dietary Supplements
During pregnancy, the nutritional requirements of the body more...

Avoiding Harmful Substances
Our organism is widely exposed to environmental pollution more...

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Collaboration

The main basis for high diagnostic accuracy and above-average therapy success lies in the interdisciplinary collaboration with other specialists.

Andrological Diagnostics (specialized urologists in Berlin)
Creation of a spermiogram and its analysis more...

Psychological Care (Margerite Marcus – Medical Doctor and
Family Therapist)
Consultations will take place as one-to-one interviews and with
the couple more...

Acupuncture (Dr. Kielkowski)
Treatments according to traditional Chinese acupuncture more...

© 2012