| Day | What happens |
|---|---|
| Last week of preceding cycle | Estrofem priming 1-0-1 (2mg morning + 2mg evening = 4mg/day) |
| CD1 | Notify Joanna before 16:00 CET when proper bleeding starts — this is the official treatment start. Folic acid orally from day 1, mandatory |
| CD2 | Begin Pergoveris hormonal stimulation |
| CD8–9 (approx.) | 1st ultrasound control — can be done in Hungary (after ~6 injections) |
| CD10–11 (approx.) | 2nd ultrasound control — highly recommended in Brno (doctor wants to see her personally before retrieval) |
| CD13–15 (approx.) | Oocyte retrieval & fertilization. Adam needs to come to Brno for fresh sperm collection. 2–3 days sexual abstinence beforehand; condom only during stim |
| CD15+ | 5–6 day embryo cultivation. Live progress visible in patient portal at unica.cz |
| Day 5/6 of culture | Biopsy for PGT-A |
| End of all stimulations | Embryo transfer once PGT-A results back (banking strategy — transfer happens after the last cycle, not after each one) |
| Element | Recommendation |
|---|---|
| Stim protocol | Stable dose, not alternating. "We don't use this viral type of protocol." Final dose set after baseline US |
| Dose | Higher than previous cycle — doctor explicitly noted possible Asian-ethnicity adjustment toward higher gonadotropin dose |
| Medication | Pergoveris (recombinant FSH+LH, "best on the market"). Existing Puregon could be used in last days of stim. Pen-based, easy to use |
| Estradiol priming | Confirmed in May 1 draft protocol — Estrofem 1-0-1 (4mg/day) in the last week of the preceding cycle |
| Stim start | Day 2 of cycle |
| Trigger | Single trigger (likely hCG); not specified beyond standard |
| Egg-yield target | ~15 eggs collected (doctor's plan); reality TBD by response |
| Day-5 embryo expectation | 3–5 (doctor's estimate; very dependent on egg quality) |
| Fertilization | ICSI always — "supposed to be more beneficial. We just do ICSI." Note: previous cycle did not use ICSI, which Andrea & Adam now consider a likely contributor to the bad outcome |
| Sperm selection | MSS chip / Zymot chip microfluidic selection — standard at Unica. MicroChip add-on €300 per May 1 email |
| Embryo culture | Wait until day 5, often day 6, rarely day 7. "Strategy of the embryologist here, definitely" |
| Time-lapse incubator | Yes, available. Embryo selection = morphological quality + PGT-A correlation |
| DuoStim | Possible only if there's a real time pressure. Default is 1-month break after retrieval; next stim no earlier than the second period after egg collection |
| Back-to-back cycles | Yes, supported. Joanna noted patients often respond better in the next cycle because the body is still hormone-primed |
| Transfers | Single transfer included with package; embryo transfer no earlier than 2 months post-retrieval (PGT-A turnaround). Banking strategy = transfer after all stimulations complete |
| Item | Detail |
|---|---|
| PGT-A lab | External genetics lab in Brno (close). Biopsy samples sent; embryos stay frozen at Unica |
| Turnaround | 3–4 weeks after biopsy |
| Karyotype | Not done previously; not mandatory at Unica |
| DNA fragmentation | Not needed when using MSS chip sperm selection |
| Sex selection | Not possible — CZ law prohibits unless there's an X-linked or Y-linked disease. PGT-A report does not include gender information |
| Storage cap | No time limit on embryo storage. Treatment age cap is Andrea's 49th birthday — after that they'd ship embryos to another country (e.g. Spain, where treatment up to 50+ is allowed) |
| Item | Price |
|---|---|
| ★ Low-Responder 2+1 Exclusive + PGT-A (recommended) | €9,500 for 3 cycles — biopsy + 1 embryo PGT-A per cycle included |
| Single Exclusive + PGT-A | €4,750 / cycle |
| Each additional embryo PGT-A | €425 |
| Anesthesia (per retrieval) | €200 |
| MicroChip (sperm selection) | €300 |
| Embryo freezing | €450 for up to 3 embryos; +€100 per additional embryo. Not included in the package |
| Pergoveris pen 900 IU | €481 — expect ~2.5 pens per stimulation cycle (~€1,200/cycle in meds) |
| AMH retest | €45 (Joanna recommended — current value is 5 months old) |
| Ultrasounds & spermiogram (in-clinic) | Included in the package |
| For | Recommendation |
|---|---|
| Adam | Folandrol, FertilMan Plus, Nucleox, Proxeed Plus, or Supramen — anything containing MACA (plant extract). Avoid overheating the testicular area — loose underwear, no sauna. Start asap |
| Andrea | Folic acid (e.g. Femibion). Vaginal probiotics also recommended |
| IVF Cube | ReproGenesis | Repromeda | Unica | |
|---|---|---|---|---|
| Doctor met | Dr. Stasna | Dr. Maderka | Dr. Filková | Doctor (name TBC) |
| Location | Prague | Brno | Brno | Brno |
| Doctor impression | Strong, decisive | Excellent bedside manner | Most thorough of all 7 | Fine, nothing special |
| Coordinator impression | Solid | Solid | Strong (Adéla) | Strong (Joanna) |
| Preferred med | Pergoveris | Menopur | Gonal-F + Pergoveris | Pergoveris |
| ICSI | Always | Standard | Always | Always |
| Sperm selection | Microfluidic standard | Not needed if normal | MAX + Zymot + PIXI | MSS / Zymot chip |
| HU monitoring | Limited | Yes | Yes (LilyMed) | Partial (1st US only) |
| 2nd US in person | Not specified | Yes | Recommended | Required (CD10/11) |
| DuoStim | Not a fan | Possible, last cycle | No (doctor) | Only if urgent |
| Sex selection | No (CZ law) | No (CZ law) | Preference noted, not guaranteed | No (CZ law) |
| 200/400 dosing | Flagged | Flagged | n/a | Flagged ("strange") |
| 3-cycle headline | ~6,150/cyc | ~6,705/cyc | ~5,847/cyc (SpermPacket) | ~6,167/cyc (2+1 + add-ons) |
| Multi-cycle discount | None | Ask | Ask financial dir. | Yes — 2+1 deal €9,500 |
| HU patient share | n/a | n/a | n/a | >50% in Brno |