Dr. med. Sylke Reichel-Fentz – Transfusion Medicine

Fertility is an important topic for many people

Welcome on our homepage – and
thank you for your interest!

Diagnostics & Treatment Process

In-depth laboratory diagnostics aim at detecting and treating accompanying factors of infertility.

Process Details

A Presentation on Infertility

Reproductive immunology issues are increasingly important for IVF centres and specialists of other areas.

Information on Infertility

The Clinic

The early days in 1991 were characterised by limited diagnostics and very few treatment options – things have markedly changed since then.

About Clinic Dr. Sylke Reichel-Fentz

Treatment
Process

Since our patients seek our help and diagnostic services from all over Germany, Europe, and beyond, we have modified our processes to allow us to handle most things by mail, email, and on the phone.

Contacting Us

If you would like to get a second opinion from us or have additional examinations done by us, the first thing we will need is your complete personal information (both partners) and of course how and when we can reach you (by phone, mail, etc.). We will also need all your previous examination and test results in connection with your fertility treatments to date. This will allow us to avoid unnecessary double testing, specifically in the area of genetics.

Patient History

For a complete assessment of your personal situation, we will need additional information about you and your partner in addition to your test results. You can download the form we need you to fill out in either German or English in PDF format right here on the website.

...Download Patient History

Please be meticulous in filling out this form, as this information in conjunction with your examination results will form the basis of our recommendations for additional treatment options.

Costs, Billing

Patients residing in Germany who have statutory health insurance cover are urged to forward a valid letter of transferral, as we will otherwise not be able to forward you a sample set. The sample set is prepared by us in accordance with the examination results you have provided us with. It will be mailed to you. Please understand that we will have to charge this sample set to you as a private cost. Patients with private health insurance and patients residing outside Germany will receive a private invoice based on the GOÄ (German statutory fee schedule for doctors).

Blood Samples

You will be able to take the sample set to your local general practitioner and ask him to take blood samples. Please take the set with you after a sample of your blood has been taken and post it back to us immediately; the samples should ideally reach us within 24 hours. You should therefore only have blood samples done Monday to Wednesday to ensure their timely arrival at our laboratory. Should – in exceptional cases – a blood sample have to be taken on a Thursday, you will have to ensure a courier dispatch which will reach us on Friday before noon.

Assessment, Consultation

A few weeks later, once all your test and examination results are available (your waiting time may be shorter or longer, depending on the scope of examinations), you will initially receive the uncommented laboratory results. Since an individual interpretation is not always easy, I will be happy to discuss the findings and your resulting treatment plan with you. You will, of course, receive an assessment of the findings and our treatment recommendations, or a targeted treatment plan, in writing as well.

Consultation regarding third-party findings

We can also offer a consultation regarding third-party findings. Please understand that we will still have to ask you to respect the same waiting period, as it would otherwise be unfair towards patients taking advantage of our own laboratory diagnostics, who, in effect, would have to wait even longer for their results if we handled your case first. Please make sure to send us all your existing results and our completed Patient History Form.

Consultation and blood samples taken here at our clinic

You can make an appointment to have your blood samples taken here in-house and/or have a personal consultation. This type of meeting is particularly meaningful if at least the majority of your results are already available at the time of your appointment. These consultations will take place mostly in the late afternoon, once the time for phone consultations is over. The timing will ensure that there will be no time pressure for your consultation and there will be nobody waiting to be seen after you.

Treatment Measures

The aim and purpose of all diagnostics is of course finding any and all risk factors that require treatment. In many cases, this may be achieved simply with medication, or by way of a so-called active immune therapy. Active immune therapy is a treatment with partner lymphocytes in which the potential mother is immunised with lymphocytes of the potential father. Since the placenta and the embryo is a product of maternal and paternal genes and attributes, the lymphocyte therapy will help support the maternal immune system in becoming more tolerant to foreign tissue.

Partner lymphocyte treatment, LIT, active immunisation

This treatment form has been used successfully for a relatively long time. Initially it was used primarily for the treatment of patients suffering from recurrent miscarriage. Since study results regarding this treatment were very varied, is still incites controversy to this day and is in many cases regarded as a critical treatment. Significant successes have been reported, however, providing that recipient patients have been selected very carefully. This is not only a fact with respect to our own observations, but has been proven time and again in a variety of patient groups.

Rate of pregnancies carried to term after LIT depending on age
(2005 survey – own patient clientele suffering from habitual abortions)

The success rate of pregnancies carried to term in patients suffering from recurrent miscarriage is at 72%. Looking at this in terms of patient ages, the age groups 25-29 years and 30-34 years show an even greater success rate with 82% and 81% respectively.

In patients with a history of unsuccessful implantations, the pregnancy rate is increased by around 10%. Success is particularly well documented for the first 6 months after the immunisation treatment, the chances of success tend to decrease slightly after that. Refresher treatments are an option in these cases.

There is no standardised process for this particular treatment. We complete the treatment in two sessions with an interval of four weeks. The so-called success check will be conducted approximately three weeks after the second immunisation. The treatment is usually unproblematic, the immunisation site may, however, display a localised allergic reaction, comparable to a severe insect bite. The symptoms will disappear after about ten days. General allergic reactions are not expected. The treatment may, however, not be right for every couple.

Implementation and risks of partner lymphocyte treatments


Drug Treatment Support

Cortisone, Prednisolone, Dexamethasone, and others

Due to its anti-inflammatory and immune-suppressive effects, cortisone is used primarily where autoimmune risk factors exist, or where autoimmune diseases have been diagnosed. Furthermore, the activity of killer cells can be drastically reduced with cortisone. The dosages administered are generally low. Treatment is administered mostly during the IVF/ICSI cycle, and later during the early stages of pregnancy up to week 12.

Fractionated Heparin, Clexane, Fragmin P Forte

An anticoagulant is definitely advisable for patients with existing thrombosis risk factors. The treatment involves prophylactic doses. A combination with ASS 100 may be useful, specifically if phospholipid antibodies are present. A prophylactic anticoagulation treatment is advisable even if immune risk factors exist, as immune-pathological processes will always result in the activation of coagulation as well. Where the result constellation is generally normal, a treatment with low molecular weight heparins may be considered simply on the basis of empirical contemplation.

Polyvalent Immunoglobulins (IVIG)

A “passive” immune treatment is another of the tried and tested methods for infertile patients. Numerous studies date back to the 1980s and 1990s; findings are similarly controversial as with regards to active immune therapy with partner lymphocytes. This treatment is furthermore very costly. Some patients have been treated with doses up to 40g per session, which may be financially much too burdensome for many couples. The treatment does, however, still have its virtues. Specifically older patients and most importantly women with secondary infertility seem to benefit from the treatment (Christiansen and Nielsen, 2005). IVIG reduces the activity of NK cells just like cortisone. A treatment with polyvalent immunoglobulin seems to increase the success rate significantly (experiences from collaborations with a Regensburg-based fertility clinic) in cases with unfavourable KIR constellations (non-existent activating receptors).

Intralipid

This preparation is a fat emulsion produced from soy beans. It contains the fatty acids omega 6 and omega 3. Treatments with intralipid have shown a marked reduction of the activity of killer cells similar to the results achieved with cortisone and immunoglobulin. The treatment must, however, be started ahead of any IVF/ICSI attempt or pregnancy. The costs for this treatment are significantly lower than a treatment using immunoglobulin.

Granocyte

Granocyte (active ingredient lenograstim) is the same as cytokine (G-CSF). It has been used in therapeutic medicine for the stimulation of stem cell release from the bone marrow for a long time. It also has a number of other additional functions. It has, for example, been proven to exist in follicular fluid. It is also secreted by lymphocytes found in the endometrium. It can therefore be assumed that it plays a significant role in implantation. Various studies (Würfel 2010, Scarpellini and Sbracia 2009) have shown that the pregnancy rate increases significantly and that the success rate of pregnancies in patients suffering from recurrent miscarriage shows a similar increase with treatments incorporating granocyte starting from the implantation phase. There are now a variety of treatment options with granocyte available (intrauterine installation, periodic subcutaneous application during the implantation phase and early pregnancy, or the application in embryo cell culture media).