Vienna In Vitro Center, Sofia, Bulgaria > We can help > Additional methods

Additional methods

In the last few years there has been much progress in the treatment possibilites for infertility. Therefore, it has become increasingly possible to provide patients/couples with personalized treatment. Even with very specific problems a successful treatment is possible. We monitor new developments in the area of fertility treatments, inform our patients of the newest developments and offer them these new methods as soon as possible.

However, we do not want to awake any false hopes. Many of the newest methods are not routine. We test these methods carefully and strongly consider the benefits and drawbacks of each of them with regard to our patients. We only adopt methods that, at the very least, have been published in an academic journal and were consequently reviewed by a variety of international experts.


Even the smallest of changes can make a difference...

The fact that these methods are adopted by other centers is an indication that we are on the correct path.

Triple hormonal strategy

Hormonal status is an essential condition to achieve pregnancy. The problem with altering hormonal levels and diminished ovarian reserve affects more women nowadays.  The reasons  for this fact are  several: the wish for a child at a later age  of modern  women, genetic  causes, heredity,  the negative  impact of environmental  pollution, chemotherapy  and  radiotherapy.

Vienna IVF Centre offers an innovative approach: "Triple hormonal strategy" to a specific group of patients (with diminished ovarian reserve and poor response in previous stimulation for IVF).  It is based on the latest research on sets of hormonal factors, positively influencing on the effect of IVF treatment.

The complex includes the following three steps:

The first step is related to the fact that the application of certain hormones affects favorably the early stages of follicular maturation, occurring several weeks before ovulation. Treatment with a specific dosage and duration and in a certain phase of treatment increases the response to stimulation, reduces the dose of medication administered and improves embryo implantation rate in low responders.

The second step is based on the fact that suppression of follicle stimulating hormone levels during the luteal phase of the menstrual cycle improves synchronization of follicles that will grow during the controlled ovarian stimulation. As a result of this is optimization of ovarian response to gonadotropins.

The third step in "Triple hormonal strategy" refers to the implantation of the embryo in the endometrium - a key point in the pregnancy. It is known that premature changes in the uterine lining (so called histologicaly advanced endometrium) is one of the leading factors in the declining success of IVF treatment. The asynhrony which has occurred between the endometrium and the developing embryo can cause a negative result. Thus, the examination of a parameter in the early phase of stimulation and its value above a certain level  is  a prognostic marker to reducing the chance of implantation and pregnancy.

Nidation rinse

Some patients receive several embryos of good quality, however, still no pregnancy results. This failure to implant (called "repeated implantation failure" - RIF) creates a serious problem as only certain methods remain that can be used to facilitate a pregnancy.

Two blood samples are required to obtain these immune cells, one on the day of the egg cell extraction and another two days later.  These special immune cells are then obtained from these samples and placed in a culture medium. Two days after the egg cell extraction this cell solution is flushed into the uterus with the aid of a soft catheter.  This prepares the endometrium particularly well for the embryos.

As such, this special treatment is connected to two blood withdrawals and a small gynaecological procedure.

Until now, no complications have been observed as a result of this procedure.


The uterus' mucosa is essential for nidation of the embryo (fertilized egg cell). An IVF attempt can therefore fail if the mucosa is not of optimal quality (size, layer and capacity to absorb fertilized egg cells).


We offer this treatment routinely to patients, where nidation repeatedly failed following the embryo transfer. We recommend the usage of „FertiGrow" based on the following indications:

  • patients with repeatedly too structure of mucosa (less than 6-7 mm)
  • patients who have undergone several surgical treatments on the uterus (curettage after an early or late abortion)
  • failure of nidation at least twice
  • known Ashermann syndrome
  • patients where alternative methods for building up the mucosa (e.g. estrogen therapy) were inefficient

Furthermore, „FertiGrow" is applied directly free of pain into the uterus. This is conducted speedily and stress free during the egg cell collection. Thus, an additional appointment is not necessary. The substance used does not contain blood products or other materials which could harm the patient.

 Seminal plasma rinse

Foreign research groups have established the positive influence of seminal fluid on nidation.  For this purpose, a part of the seminal fluid - the seminal plasma - is separated from the cell parts and flushed into the patient's uterus with the aid of a thin catheter. 

Along with our foreign partner institutes, we have observed an increase in the pregnancy rate, and recommend this method to all couples that experienced repeated nidation failures. So far no complications resulting from this procedure have been observed.

IMPORTANT: This method is also only suitable for those patients, who had embryos of good quality transferred.  This method is not recommended, if earlier attempts involved embryos of reduced quality or the quantity of egg cells or embryos was too small.

Assisted Hatching

In order to achieve pregnancy, the embryo must leave its shell, the zona pellucida. This is essential for the success of the treatment.  To facilitate this process a special method called assisted hatching was developed.  This method involves making a hole in the shell of the embryo.  This hole can be made with the aid of a pipette, a special laser or with a biological acid.  It is not clear which of these methods is the most successful, meaning which results in the highest pregnancy rate.  The following patient groups can benefit from the assisted hatching procedure:

  • Women over 37 years of age
  • Increased FSH levels before treatment
  • Individuals with a decreased embryo quality
  • Embryos with observably thicker zona pellucida (egg shell)
  • Earlier unsuccessful treatments

How will this method be implemented?

This method requires a lot of experience. As mentioned above, however, this method does not necessarily guarantee higher chances of achieving pregnancy.

Opening in the embryo shell to support the hatching

Assisted hatching can be conducted through a variety of techniques:

  • Mechanical assisted hatching through micromanipulation with a glass needle (pictures below). The embryo will be held on one side with a special pipette. A delicate needle will be pushed through the egg shell without disturbing or injuring the cells within. The egg shell will be carefully rubbed between the pipette and the needle until a slit forms.
  • Laser assisted hatching:
  • through direct contact by the laser
  • through bundled laser light guided over the microscope lens

Embryoglue ®

Embryoglue® is a special medium for the embryo transfer which eases the embryo's adhesion to the mucous membrane of the uterus via the use of biochemical signals.  This is a culture medium specially developed for the embryo transfer.  The consistency of embryo glue is similar to that of the liquid of the mucous membrane of the uterus and contains an important substance called Hyaluronan.  This medium wraps itself around the embryo and assists in bonding of the embryo to the mucous membrane via its ‘sticky' properties.

In order to reinforce existing literature, the Kinderwunschzentrum conducted a study involving 114 patients.  This included IVF patients that had already experienced several unsuccessful IVF attempts as well as suffering from poor embryo quality.

From the results of the study, we can recommend embryo glue in the following situations:

  • Age >35 and second failure of nidation
  • Poor embryo quality regardless of age



 Nidation curettage

Nidation is an important process for the establishment of a pregnancy.  A variety of chemical messengers are needed in order to identify the embryo and allow it self to attach to the endometrium.

Noteworthy research indicates that small stimulation of the mucous membrane in the cycle before the actual treatment cycle can increase the pregnancy rate.  This stimulation can be created by means of a minor curettage.  This is performed in the second half of the menstrual cycle, meaning before the actual stimulation begins.  Even if the menstruation follows a curettage procedure, the positive effect remains.

The nidation curettage cannot be compared to a traditional curettage.  This procedure involves only a small plastic instrument inserted into the uterus of the patient in order to remove a small amount of the mucous membrane.

This procedure is not a routine method as it is time consuming and requires a minor procedure. This method is applied only for select couples who have had previous unsuccessful treatments.


(Physiological Intracytoplasmic Sperm Injection)

This method involves the selection of a few sperm cells which bind well with hyaluronic acid.  These sperm cells show fewer genetic defects (so-called ‘DNA strand breaks") and commonly contain a normal nucleus.

The injection of these specially selected sperm cells improves the embryo quality and development.

In order to perform the PICSI procedure sperm cells of a certain quantity and motility are necessary. It is not possible to obtain such sperm cells in every sperm sample.

The PICSI method is not routinely carried out due to the fact that it is time consuming and requires particular laboratory experience.  As a result, this method is used only with select patients for whom the ICSI method was unsuccessful.

The new possibilities to examine DNA strand-breakage provide opportunities to select patients who can benefit from the PICSI method.

Rescue ICSI

Even if normal sperm cells are obtainable it is possible that only a few or no egg cells can be fertilized. The causes for this can be the poor quality of the egg cells or defects in sperm cells that cannot be discovered using a regular semen analysis. 

Normally, the egg cell removal is followed by an IVF treatment on the same day and by the second day an assessment can be made as to whether an egg cell was successfully fertilized. If no egg cell has been fertilized by the second day, a fertilization failure is likely and a so-called "rescue ICSI" procedure can be performed.

The chances for fertilization using this technique are decreased as at this point the egg cell is already one day old. In case no fertilization occurs as a result of this method for the next treatment, the ICSI method is recommended on the day of the egg cell removal.

IMPORTANT: Therefore, the IVF method and the ICSI method are distinguishable from the rescue ICSI method by the fact that the former is used on the day of the egg cell removal and the latter as an emergency procedure on the day following the removal if the IVF method did not succeed.

Ca2+ ionophore medium

A special medium used to 'activate' the egg cells right after the ICSI has been performed.

The incubation of egg cells with Ca2+ ionophore medium is recommended if:

  • no fertilization after ICSI
  • low % of fertilized eggs after ICSI (below 50%)
  • severe male factor
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