FertiGenève is a joint venture between leading Swiss partners in the field of assisted reproductive technology (ART), from both the public and private sectors. They have joined forces to create a centre of clinical expertise to help couples with fertility issues and to provide them with the best possible care as they try to conceive.

This partnership brings together various fertility experts, gynaecologists and urologists, and a laboratory equipped with the most advanced assisted reproductive technology (ART) at their disposal.

Find out more: About

Firstly, contact one of the specialist doctors at the FertiGenève Centre of Clinical Expertise. The gynaecologist you have chosen will support you throughout your journey to ensure you receive personalized care as you seek to start your family.

Find out more: Journey

It is important for both partners to attend this first appointment. The doctor you have chosen from the FertiGenève list will ask both of you questions about your general health and any factors that might be contributing to your infertility (frequency of intercourse, sexual difficulties, the regularity of your menstrual cycle, sexually transmitted infections, etc.) The doctor will also familiarize himself or herself with any tests that may already have been conducted by your general practitioner and will suggest additional targeted examinations. A second appointment will be scheduled, during which the doctor will explain the results of your examinations and offer you the most appropriate course of treatment.

If necessary, your case will be discussed at a multidisciplinary meeting involving a range of FertiGenève specialists.

Find out more: Journey

Infertility is defined as the inability to conceive after 12 months or more of unprotected sexual intercourse. Some 10 to 15% of couples in Switzerland face this problem.

Infertility can be a male as well as a female issue: around 30% of cases affecting a couple are attributable to the female, and 30% to the male. In the final third, infertility is attributable to both partners or is unexplained (up to 20% of cases).

This is why it is important for tests to be offered to both partners in an attempt to identify the cause of the problem and determine the most appropriate treatment.

Female infertility can have several causes:

• Ovulation problems: around a third of infertile women have an ovulation problem. This manifests in irregular or infrequent menstrual cycles (oligomenorrhea) or no periods whatsoever (amenorrhea). In this case, the production of a fertilizable egg is rare or non-existent and it is consequently impossible to become pregnant. Ovulation problems are the consequence of hormone disorders of varying origin, including polycystic ovary syndrome, physical stress (due to eating disorders or excessive physical exercise) or mental health issues, thyroid issues, obesity, etc.
• Damaged or blocked tubes: the fallopian tubes connect the ovaries to the uterus and are therefore an essential reproductive organ. In most cases, fallopian tube lesions are the result of a sexually transmitted infection but they are also linked to endometriosis or may be caused by surgery.
• Uterine conditions: uterine malformations, adhesions (scar tissue) or uterine fibroids can cause embryo implantation failure, thereby reducing the chances of pregnancy.
• Endometriosis: a frequent gynaecological condition in which endometrial cells (the tissue that lines the inside of the uterus that is shed during menstruation) grow outside the uterus. Endometriosis can cause ovarian cysts and adhesions that potentially prevent the egg from entering the fallopian tube.
• Age: in today’s society, women are waiting increasingly longer before they try for a first pregnancy. This is a significant contributory factor for increased infertility, since the chances of pregnancy decrease with age.

A semen analysis or spermogram is the baseline test. This involves examining the density, motility and shape of the sperm. If the result is abnormal, other examinations, such as a hormonal assessment and identification of any infections, will be performed. If the sperm quality is very poor, an assessment by a urologist andrologist will be offered. If there are no or very few sperms, a genetic analysis and potentially a testicular exploration will be recommended. If sperms are found at this point, a sample can be collected and frozen for assisted reproductive technology.

Several factors should be considered for fertility protection:

• Age: women’s fertility is at its peak between 20 and 30 years of age, after which it declines in line with the fall in the number and quality of egg cells. This phenomenon is genetically programmed and irreversible.
• Weight: infertility is more common in people who are either obese or underweight.
• Sexually transmitted infections: some infections, such as chlamydia, can pass unnoticed but cause irreversible damage to the fallopian tubes. Using protection is recommended to limit the risk.
• Tobacco: tobacco impacts the cardiovascular system and lungs, as well as affecting female and male fertility. Women who smoke enter the menopause on average one to two years earlier than non-smokers. In men, tobacco reduces the quality of sperm cells and the chances of success with assisted reproductive technology. Other substances, such as cannabis, also reduce fertility.

The majority of infertility treatments are authorized in Switzerland. This includes ovulation induction treatments, intrauterine insemination with the husband’s sperm and in vitro fertilization. The amendment to the Federal Act on Medically Assisted Reproduction (LPMA), which was implemented in 2017, helped to optimize the chances of pregnancy by allowing a longer culture time and embryo freezing, as well as preimplantation genetic testing.

Insemination with donor sperm is also authorized for married couples. Female married couples have been entitled to use sperm donation since 1 July 2022, following the vote on 26 September 2021, which allowed same-sex couples to marry.

Sperm donation is allowed for married couples. In addition to heterosexual couples, female married couples have been entitled to use sperm donation since 1 July 2022.

In vitro fertilization (IVF) was introduced in 1978 and is the most effective assisted reproductive technology. In Switzerland, one child in 40 is currently born following IVF treatment. With IVF, the fertilization process is completed outside the human body by combining eggs and sperm cells in the laboratory. Once fertilized, the eggs divide and become embryos. Embryo development is observed in the laboratory for a few days; in most cases, the embryo is transferred into the uterus, where implantation and pregnancy may occur.

Find out more: In vitro fertilization or intracytoplasmic sperm injection (ICSI)

Ovarian hyperstimulation syndrome (OHSS)
OHSS is the consequence of an exaggerated response to the gonadotropins used for ovarian stimulation. The ovaries are enlarged with multiple follicles, which produce a large quantity of oestrogen. Increased permeability of the blood vessels causes fluid to leak into the abdominal cavity. OHSS is accompanied by a feeling of discomfort, nausea and abdominal swelling. Mild OHSS resolves rapidly at the end of treatment and has no further consequences. It is more severe in 1 to 5% of cases. It then requires the preventive administration of anticoagulants as it increases the formation of blood clots in the veins (thrombosis), and in some cases necessitates hospitalization for hydration and monitoring. Current stimulation protocols and the latest IVF strategies have significantly reduced the risk of OHSS.

Complications of egg retrieval
Although it is a minor surgical procedure, inserting a needle into the abdomen can cause an infection or internal bleeding. Fortunately, however, these complications are rare (0.01 to 0.1% of cases).

Multiple pregnancy
This represents an increased risk for the mother and future children, including premature childbirth, prolonged bed rest, hospitalization, Caesarean section, etc. The implementation of the LPMA amendment in 2017 helped to significantly reduce the risk of multiple pregnancy without reducing the pregnancy rate. The risk fell from 15.6% in 2016 to 4.3% in 2020, while the childbirth rate per patient increased from 31 to 34%.

IVF was developed to produce a pregnancy in women whose fallopian tubes were damaged or missing. Nowadays, it is used to treat various causes of infertility such as endometriosis, male infertility, unexplained infertility, etc. In accordance with Swiss federal law (LPMA), IVF is only offered when simpler treatments, such as ovarian stimulation, intrauterine insemination or an attempted surgical correction are inappropriate or have already failed.

Find out more: Treatments

Preimplantation genetic tests involve taking cells from an embryo produced by in vitro fertilization to analyze their genetic material. This enables the selection of the embryo to be transferred to the uterus. The embryos are cryopreserved pending the results of the genetic tests.

There are three situations in which PGT is indicated:

• Couples who carry a serious genetic disease that is likely to be passed on to their child (PGT-M)
• Couples where one of the partners has a chromosomal rearrangement. These exchanges of genetic material between two chromosomes result in more frequent chromosomal imbalances in the embryo, with an increased risk of miscarriage or malformation (PGT-SR)
• Women over the age of 38, who have had several unsuccessful treatments. This test is used to determine the number of chromosomes in the embryo, given that older women produce more embryos with chromosomal anomalies and that these embryos have very little or no chance of developing into a baby (PGT-A). This is the most frequent indication.

The Fertas Laboratory in Geneva, a member of the FertiGenève Centre of Clinical Expertise, is equipped to cryopreserve embryos using a process called vitrification. Embryos that are preserved in this way can subsequently be transferred into the uterus, without the need to repeat the egg retrieval and fertilization stages.

Find out more: Freezing

Egg freezing using vitrification is intended for women who need to undergo a complex treatment such as chemotherapy, which is likely to affect their fertility, as well as for healthy women who simply want to defer their pregnancy.

Find out more: Freezing