FAQs

Assisted Reproductive Technologies

1. Are there any age limits for the infertility treatment using both own and donor’s oocytes?

There are. Only women not older than 40 can take infertility treatment using their own oocytes, (according to the order of the Ministry of health of Ukraine # 24 from February 4th 1997). If you use donor’s eggs there is no age limit.

2. What are the indications for having donor eggs?

You are recommended to have donor eggs if you are above 40.

If you have high level of follicle-stimulating hormone (FSH) in blood.

If you have no ovaries (aplasia, medical or mechanical castration); premature ovarian failure (POF)

If you have made numerous unsuccessful attempts of IVF and the quality of oocytes was bad or ovarian response to the stimulation was insufficient (even if the maximum FSH doses were used).

If you have benign or malign formations of different locations, including ovaries (increased level of oncomarker CA-125).*

If you have any type of genetic diseases.*

*- If there are no contra-indications to child-bearing.

3. How are the oocyte (sperm) donors matched for the recipients?

They are selected on the basis of the phenotype profile which the patient fills in.

4. How are the recipient’s and donor’s cycles synchronized?

The cycles of the recipient and the donor are synchronized by agonists gonadotrophin-releasing hormones. When donor and the recipient reach down regulation they start the second phase of preparation by valerate (valerianate) estrodiol and progestin.

5. What is “down regulation”?

It is a temporary blocking of lutheinizing hormone (LH) and follicle stimulating hormone (FSH) in order to start preparation for IVF and Embryo Transfer (ET) “on the clear background” (without any ovarian cysts and endometrium thickness less than 4mm).

6. Do they use steroids in standard protocols for preparation in donor cycles? Are there any side effects?

Steroids are not used in the standard protocols.

7. Is there any standard protocol of treatment when using donor eggs? What are the medicines, their active substances and doses?

We have a Standard protocol approved by the Clinic. The medicines we use are: analogues of gonadotropin-releasing hormone, estrogene medications; after the transfer – progesterone medications.

Donors receive menotropines – human menopause gonadotrophin (HMG). The dosage is individual.

8. How many embryos are transferred into the womb cavity?

We transfer 2-3 embryos, depending on the patient's age and medical history.

9. What is the optimal endometrium thickness for the embryo transfer?

According to different sources of information 7-12 mm are optimal.

10. What are the guidelines after the embryo transfer (like food, sex restrictions)?

Our recommendations are:

• taking Progestrone and estrogen medications;
• physical and psychological rest until the test for Human Chorial Gonadotrophin (HCG), (no sex and physical activity and pressures), later on doctor’s recommendation;
• no hot baths, saunas, solariums;
• no alcohol, smoking and spicy food.

11. What day after the transfer is a flight possible?

There is no information concerning flight influence on pregnancy.

12. How long the prescribed drugs should be taken after the embryo transfer?

The medicines are taken until the HCG test.

If the test result is negative the medications are quitted.

If the result is positive, you continue to take medicines till the pregnancy is diagnosed by ultrasound, and if the pregnancy is developing in a normal way (there is no risk of miscarriage) drugs are taken till the 12th week of pregnancy. Then the dosage is gradually reduced till final stopping.

13. What is IVF?

'In vitro Fertilisation' (IVF) involves the retrieval of follicles from a female client followed by fertilisation of the follicle with the husband's (or donor's) sperm. The fertilised follicle is subsequently monitored in our laboratory monitoring for embryo development and as a final step is transferred back into the woman's uterus.

The above IVF method was first successfully used in England in 1978. Presently, thousands of children are born due to this highly successful method.

14. Who should be treated by IVF?

IVF can be successfully used for treatment of almost all forms of infertility. As a rule, IVF is indicated for those couples who can not conceive after one year of regular sexual relations (intercourse) without contraception. In addition, IVF can be successfully used in patients having the following infertility problems:

Blockage of the uterine tubules (the female patient's 'tubes')or commissure process in the small pelvis negatively impact on the anatomy of the uterine tubes and/or the ovaries.

Severe form of spermatogenesis pathology (i.e. abnormal sperm development).

Failure to conceive after 3-6 cycles of ovarian stimulation / intrauterine insemination.

15. How is IVF treatment performed?

Firstly, the client is provided the application form as well as an consent form / agreement which provides information regarding IVF treatment. After discussions with ISIDA-IVF staff regarding all aspects of the IVF procedure(s) , the agreement is signed by the infertile couple and ISIDA-IVF.

As a rule, the woman receives 10-12 days of ovarian stimulation with intramuscular (i.e. into the muscle) or subcutaneous (i.e. under the skin) injection of medications in order to achieve the growth of several follicles (round sacks, filled with liquid, where oocytes reside). From the 8-th day of ovarian stimulation, ISIDA-IVF staff tests the hormonal concentration in the blood every 2 - 3 days. Additionally, ultrasound vaginal monitoring is carried out to monitor for appropriate follicular growth and development.

After obtaining full follicular maturation, the ISIDA-IVF physician uses a special needle to puncture the follicle to withdraw the follicular liquid which contains the oocytes ('eggs'). This procedure is safely and painlessly performed by the ISIDA-IVF team, using anaesthetics to ensure patient comfort. The oocytes that are retrieved are then fertilised using the husband's or donor sperm. In the case of severe abnormalities in donor sperm development, a more advanced technology is used to help compensate for the latter (ICSI program).

The embryos are grown in a special medium (liquid) in the ISIDA-IVF laboratory for 3-5 days. On the 3, 4-th or 5-th day following the procedure for removal of oocytes, the successfully cultivated embryo(s) are transferred into the uterus for implantation and success of the above by the birth of a new baby boy or girl.

Obstetrics

1. Could my husband (mother) be present during the delivery?

The husband of the patient + 1 person (mother or translator or personal doctor) can be present during the labour management (natural delivery). They are obliged to take 4 tests and keep to the rules of the internal service: blood test on syphilis, blood test on AIDS, discharge from the nose on staphylococcus (Hospital Isida provides with these tests) + X-ray of lungs (Isida does not provide with this procedure).

In case of presence of the doctor from the other medical facility (Patient’s application) his presence during the labour is regulated by “Regulations of the presence of the doctor and other medical specialist who are not collaborators of the Hospital”.

As for the cesarean section the husband’s present (application form) is possible only in case of permit of the medical director.

The Rules of the internal service for the visitors who are present during the medical manipulations and medical interventions.

• It is possible for the visitor to be present during the management of the medical procedures only in case of permit of the doctor in charge;
• The visitor must put on the gown, shoe covers, mask and cap;
• It is forbidden to take photos and video filming during the management of the medical manipulations and medical interventions with the exception of the natural delivery;
• The visitor must not intervene in the treatment process during the management of the procedure, interrupt the doctor and medical staff by talks, questions and advice;
• It is strictly forbidden to speak loudly and use a mobile phone without the doctor’s permit during the consultation;
• It is strictly forbidden to touch devices, instruments that are situated in the premises;
• The visitor must stay at that place of the room that was proposed by the doctor;
• The visitor must leave the used materials (gowns, shoe covers) in the litter-bins;
• The staff of the Hospital has right to ask the visitors to leave the premises in case of unethical behavior;
• It is forbidden for the visitors and relatives to be present in the operative-room with the exception of cases foreseen by the internal regulations of the Hospital (for instance, during the natural delivery of the patient). The visitors have to keep to the recommendations of the medical staff of the Hospital.

2. Is it possible to choose the doctor for the labour management recommended by my friends?

Yes, it is possible to choose the obstetrician-gynecologist for the labour management and also neonatologist and anaesthetist from the list of the doctors providing such services at the Isida Hospital. You will pay additionally to the labour management agreement 3000 hryvna for the services of the obstetrician-gynecologist, 1800 hryvna for the neonatologist, 1800 hryvna for the anaesthetist.

In case the PATIENT pay the Consultative delivery package (obstetrician-gynecologist, anesthesiologist, neonatologist), the chosen doctor despite her/his time schedule, week-ends, holidays, at night time is obliged to come to the HOSPITAL for the labour management (cesarean section) of the PATIENT.

3. Does the Isida hospital provide with the circumcision after the birth of my child?

No, it does not.

4. What kind of cloth do I need during my hospital stay? For my future child?

Isida Hospital provides with all necessary cloth for the patient (night dress, slippers, gown) and for the newborn (diapers, pampers, small bottles, nipples and soothers, milk formulas). But if you prefer your own cloth for you and your baby, please, put on it. There are no any restrictions. But the cloth for the baby should be washed and ironed.

5. What kind of documents do I need for the registration of my child?

You must register your child at your embassy and at the Ukrainian civilian registry office. You need the following documents: translation of the mother’s passport into Ukrainian, translation of the father’s passport into Ukrainian, translation of the marriage certificate into Ukrainian with appostille (translation must be notarially confirmed), confirmation from Isida.

6. What is the order of the admission to the hospital in case of labour contractions or rupture of the amniotic fluids membrane? Does the hospital provide with the transportation?

In case of labour contractions or rupture of the amniotic fluids membrane or false labour pains the patient calls to the hospital (or directly to the doctor chosen for the labour management) and informs Isida about her arrival.

The woman in childbirth can be admitted to the hospital at the period of labour contractions (the call of the ambulance car for the transportation is executed on Patient’s own).

The program of the labor management includes:

• The hospitalization to the in-patient department of the hospital for the labour;
• The hospitalization is carried out to the wards of the pregnancy failure department (before labour starts) or at the maternity department directly. The hospitalization to the wards of the pregnancy pathology (one-bed wards with all conveniences) is carried out on medical indications for the period not more then 7 days. The prolong hospital stay at the in-patient department demands the extra payment in accordance with the Price-List of the HOSPITAL. The hospital stay at the ward of the “lux” type demands the extra payment;
• After the hospitalization the PATIENT is examined by the chief of the obstetric department, by the doctor of the obstetric department, by the duty doctor (at night time and during week-ends);
• If it is necessary – the involvement of the consultants.

7. How many days will I stay at the hospital in case of physiological delivery, cesarean section?

Under the terms of the Agreement the Patient stays 3-4 days (physiological delivery) at the postnatal department, 5-6 days in case of Cesarean section ((in case of medical indications from the Mother’s or Newborn’s side the Patient stays additional time at the hospital without the payment (see terms of the Agreement)).

8. Does the hospital provide with the baby nursing and what does it include? What medical service do you provide in case of preterm newborn?

The program of providing with the medical help to newborn children.

This program includes:

• presence of the neonatologist during the labor;
• administration of the first reanimation aid (if it is necessary);
• everyday examination of the newborn by the neonatologist;
• mother’s teaching of the rules of taking care about the newborn;
• vaccination against hepatitis B and BCG (written assent of the mother);
• joint staying of the mother and baby (if there are no contraindications from both sides);
• examination of the baby’s orthopedist; • screening on phenylketonuria and hypothyroidism;
• ultrasound examination (if there are medical indications): neurosonography, heart ultrasound examination, kidney ultrasound examination;
• baby nursing for 24 hours if the joint staying of the mother and the baby is impossible because of the mother’s health status (medical contraindications);
• providing the newborns of the medical help to that need reanimation aid, intensive therapy, intensive care (the carrying out of the artificial lung ventilation, monitoring, fluid management and phototeraphy using modern equipment, the ex-ray);
• hospital stay of the newborn in the ward of the intensive care without the mother when there are some lapses from the physiological development of the early neonatologic period (asphyxia during labors, chronic pre-natal fetal hypoxia, hemolytic disease of newborns, prematurity, fetal hypotrophy, etc.);
• neonatologist’s providing of the mother with the complete information about the baby’s health status; the proving the relatives with information on condition of the mother’s consent;
• visits of the baby by the mother and by the other persons on condition of the mother’s consent in the ward of the intensive care according to the set regime of the HOSPITAL with the observance of the corresponding sanitaric and hygienic norms;
• carrying out of the lab methods of the investigation within possibilities of the HOSPITAL (full-scaled blood test);
• in case of some surgical pathology of the newborn the baby is transferred to the specialized clinic of Kiev for surgical correction of this very pathology;
• in case of grave condition of the newborn demanding the prolong artificial lung ventilation, in case of pathological baby’s status demanding the long-term staying and treatment in the conditions of the day-and-night hospital, according to the decision of the board of doctors the transportation of the newborn is possible to other medical institutions of Kiev that specialize on this pathology;
• should the necessity to treat the newborn at the HOSPITAL more than 21 days it demands the extra payment.

In case of treatment of the mature newborn (the child who has been born at the period of the pregnancy since 37 up to 42 full weeks of the pregnancy) at the Hospital on medical indications the hospital stay of the Patient is possible during 15 days without payment, the major period of the hospital stay is possible for the additional payment according to the current PRICE LIST if there are places available.

In case of treatment of the premature newborn (the child who has been born at the period of the pregnancy since 22 full weeks to 37 weeks of the pregnancy) at the Hospital on medical indications the hospital stay of the Patient is possible during 21 days without payment, the major period of the hospital stay is possible for the additional payment according to the current PRICE LIST if there are places available.

The program of the medical help to premature newborn children.

This program includes the following medical help:

• Artificial ventilation of lungs;
• Introduction of the surfactant;
• Conduction of the infusion therapy;
• Enteral (tube) feeding;
• Diagnostic X-ray photography;
• Neurosonography;
• Consultations of particular specialists;
• Monitoring of vital functions of the body;
• Laboratory examinations;
• The period of the treatment of the premature newborn children at the Hospital is up to discharge from the Hospital.

All mentioned above measures are carried out under medical medications. This program does not include: medical help to the newborn after its leaving in-patient department of the hospital.

9. Could I determinate the labour management agreement (on some reasons) and would the hospital reimburse me money?

In case of determination/denunciation of the Agreement before the term of its expiry on the initiative of the PATIENT or the HOSPITAL and also because of medical indications that constitute the inexpediency and impossibility of future providing of the medical help, the PATIENT is compensated the paid sum during five days with the exception of the price of the medical services provided already by the HOSPITAL.

10. Could my relatives and friends visit me during my hospital stay and what is the order of it?

The Rules of the internal service for the visitors of the patients being at the in-patient department:

• To put on one-time gown and shoe covers at the entry of the in-patient department;
• To keep silence during their visits at the wards of the in-patient department;
• It is forbidden to stay at the wards at night time with the exception of such cases: if it is necessary to be under observation of the relatives, namely in case of congenital and acquired pathology or phycho-emotional disorders of the patient, hospital stay of the patient at the ward “lux” and at the delivery room of the family type;
• It is forbidden for the visitors to attend other premises of the Hospital;
• The visitors are not provided with food, utensils, things of the personal hygiene;
• In case of hospital stay of the patient at the intensive care unit, the relatives have not right to live at the wards of the department;
• The visitors are obliged to behave correctly with the doctors and medical staff of the Hospital;
• It is forbidden to visit patients at the alcoholic or drug intoxication;
• It is possible to visit the patients at the intensive care unit only by the authority of the chief of the department or duty doctor- anaesthetist and patient’s resolution;
• The quantity of the visitors can’t be more than 2 persons at the same time;
• The time for the visits is up to 21.00 p.m. according to the treatment regime;
• The presence of the visitor is strictly forbidden after 22.00 p.m. at the patient’s ward of the intensive care unit (if the visitor stayed for the night sleeping in other department of the Hospital);
• It is forbidden to leave children regardless of their age at night time at the wards;
• It is forbidden to bring flowers with strong odor for the patients and leave them at the wards. They can give rise allergy;
• for the visitors who stay for the night sleeping in the departments of the hospital.

The Rules of the daily routine concern the visitors who stay for the night sleeping

• To behave correctly with the medical staff of the Hospital;
• The visitors are not provided with food, utensils, things of the personal hygiene;
• It is forbidden to attend other premises of the Hospital for the visitors who stay for the night sleeping in the departments of the Hospital.

11. Would the doctor inform me about the procedures during the delivery and ask my permission e.g. to the application of the midwifery forceps?

The doctor is obliged to inform the PATIENT about her health status (and also about the health status of her newborn(s)), including the data about the results of her examination, diagnosis (in case of identifying the disease) and prognosis, possible variants of the medical intervention, their foreseen consequences and expected results of providing of the medical help.

The tactics of the labour management may be changed should any deviations from the physiological development of the labour. In such cases the PATIENT may be done the following operations:

а) episiotomy;

b) stitching of the rupture of the maternal passages;

c) midwifery forceps;

d) fetal vacuum-extraction;

e) cesarean section;

f) manual examination of the womb;

g) instrumental exploration of the womb;

h) devisceration (stillbirth);

j) womb extraction (in case of the uterine bleeding that is dangerous to woman’s health);

k) urgent cesarean section.

The foregoing operations don’t demand the additional payment and are provided only on medical indications.

12. What kind of anesthesia do your doctors use during the physiological delivery? Cesarean section?

They use epidural anesthesia.

Epidural anesthesia – the method of the anesthesia used in case of operative measures and labor, that is carried out through the introduction of the medical substance for the local anesthesia to nerve trunks at their outlet from the spinal cord.

13. Does the Labour Agreement include nutrition at the hospital? Would it be enough for me (nursing mother) at the postnatal period?

Isida Hospital offers the diet №15 at the prenatal period and diet № 5 at the postnatal period. The patient can choose available food in the menu. The menu consists of breakfast, lunch, (afternoon) snack, dinner, (evening) snack. These diets are approved by the director of the epidemic safety, chief of the nutrition unit, chief of the obstetrics and chief of the neonatal department. We have never had any complains (quantity and quality) from our patients.