If a couple has not been able to conceive naturally within one year, despite having regular unprotected sexual intercourse, they can talk about this concern to a gynaecologist and an andrologist. But you can always seek advice earlier and, if necessary, have your fertility tested on a regular basis. It is definitely worth asking for advice immediately if a woman’s menstrual cycle is repeatedly irregular or the period is very painful.

The causes of infertility can be highly varied. In general, 30% of cases of infertility are the result of problems with the female, 30% with the male, 20% are a result of both, and in approx. 20% of the cases the causes are still unclear.

The biggest factor in a woman’s fertility is her age, as the number and quality of eggs begin to gradually decline after the age of 30. The most common causes of female infertility are, for example, ovulation disorders, i.e. disorders of egg maturation and release from the ovary, blockage of the fallopian tubes, and endometriosis.

Male fertility is assessed by the count, motility and shape of the sperm. In our clinic, men can conveniently give a semen analysis, the results of which will be available in a few days at the latest. If the parameters mentioned above are below normal, there may be problems with fertilising the egg naturally.

The causes of infertility can be genetic, anatomical or the result of previous illnesses (e.g. genital infections). What can never be underestimated is the impact of environmental factors on fertility.

Initial examinations of a woman include a vaginal ultrasound examination and, if necessary, a fallopian tube permeability test. Various hormonal analyses help to assess the egg reserve and the regularity of the menstrual cycle. Our experienced gynaecologists will provide comprehensive advice to find a solution.

The primary fertility test in a man is a semen analysis that assesses the count, motility and shape of the sperm.

It is certainly necessary to test both the woman and the man for the most common sexually transmitted diseases (e.g. HIV, HBV, HCV, Syphilis, Chlamydia, Conorrhea, Trichomonas).

Intrauterine insemination (IUI) is one of the primary methods of in vitro fertilisation. In IUI, a man’s sperm are inserted into a woman’s uterus using a special catheter, taking into account the ovulation time of the egg. This procedure is recommended if the cause of infertility is unclear or the man’s sperm count has fallen slightly. For intrauterine insemination to be successful, the woman’s fallopian tubes must be permeable. The IUI procedure can also be performed with donor sperm from our biobank.

In vitro fertilisation is preceded by the woman’s preparatory treatment, which involves stimulation of the ovaries with hormonal drugs. While a woman usually matures one (or less often two) eggs a month, an average of 10–15 eggs mature at a time during the preparatory treatment. Preparatory treatment lasts 2–3 weeks.

The eggs are removed in a short procedure (15 min) using mild anaesthesia. The doctor punctures the ovaries with a special needle, which is used to remove the eggs, which are then quickly transported to the laboratory.

In vitro fertilisation means that the female and male gametes are assembled in laboratory conditions. Classical IVF (in vitro fertilisation) means that a number of sperm are dripped onto the eggs and fertilisation takes place in a Petri dish. If sperm counts are low or previous classical IVF has failed, an ICSI (intracytoplasmic sperm injection) procedure is recommended. In ICSI, an embryologist injects a single sperm into the egg using a microscope with micromanipulators.

Gametes and developing embryos are cultured in incubators for 1–6 days.

The embryologist selects the best quality embryo(s) for transplantation, the development of which corresponds to the expected stage of development. The number of embryos to be transferred is agreed with the patient. In Estonia, it is permitted to transfer up to 3 embryos, but it is common practice to transfer 1 embryo (rarely 2) in order to avoid the risks associated with multiple pregnancies.

An embryo transfer is a procedure in which a doctor transfers embryos from a laboratory into a woman’s uterus using a special catheter. For embryo transfer, the woman must come with a full bladder (drink more water and avoid going to the toilet for 1 hour before the procedure).

All good-quality embryos that are not transplanted to a woman can be frozen and stored in a liquid nitrogen environment. In Estonia, embryos can be stored frozen for up to 7 years. Once the necessity arises, frozen embryos can re-thawed and used in the frozen embryo transfer (FET) procedure.

If the number and/or quality of a woman’s or man’s own gametes is significantly reduced or there are no gametes at all, the use of donor gametes (donor eggs and/or donor sperm) is recommended.

In general, women over the age of 43 need donor eggs. In the absence of a male partner, the woman can use donor sperm. A suitable source for this is the Next Fertility Nordic biobank – our own donor gamete bank where you will find suitable cells quickly, without having to go on a waiting list. Read about ordering donor gametes here.

The process of selecting gamete donors is lengthy and thorough. Candidate donors undergo extensive counselling and health screening. Both the egg and sperm donors are tested for sexually transmitted diseases and a number of genetic tests are carried out.

In Estonia, an egg donor can be a mentally and physically healthy woman up to 35 years old, while a sperm donor can be a man up to 40 years old. The egg donors in our clinic are mostly healthy women up to the age of 30 and the sperm donors are healthy men up to the age of 35.

If there is a risk in the family of transmitting a genetic disease to the unborn child, it is possible to perform embryo diagnostics, i.e. genetic testing of the embryos before transplantation into the woman’s uterus. Prior consultation with a geneticist is required to determine the genetic risk.

PGT (preimplantation genetic testing) is also recommended if the IVF procedure has repeatedly failed or there have been repeated abortions.

Following embryo transfer, the woman should continue treatment to support the uterus and the development of the pregnancy, as directed by a doctor, and take a pregnancy test (preferably a blood test, HCG test) after two weeks. To detect clinical pregnancy (6–8 weeks of gestation), an ultrasound examination is performed to check the foetal heart rate and ‘confirm’ the pregnancy.

The pregnancy can be registered and further monitored by our midwives at Next Fertility Nordic or elsewhere at a women’s clinic or pregnancy centre that best suits you.