In Vitro Fertilization IVF & ICSI

Infertility - diagnosis and treatment

Infertility is defined as failure to achieve pregnancy after a year of unprotected sexual intercourse.
About 15% of all couples may face infertility. Infertility investigations are commonly conducted on both partners at the same time.

The process of clarification for the woman:

Relevant laboratory tests

Ultrasound examination of the uterus and ovaries

physical examination

Medical history review

Investigating a possible mechanical cause

Infertility due to a mechanical problem refers to an anatomical issue within the pelvis that either prevents the sperm and egg from meeting or hinders the embryo from implanting in the uterus.
Common examples of such issues include pelvic adhesions and blocked fallopian tubes.

Pelvic adhesions are typically the result of previous infections or surgical procedures, such as those performed for ectopic pregnancies, ovarian cysts, cesarean sections, or fibroid removal.
Another common cause is endometriosis, a condition in which endometrial-like tissue grows outside the uterus. Endometriosis frequently leads to pelvic adhesions and is a well-recognized cause of mechanical infertility.

The following diagnostic tests may help identify mechanical causes of infertility:

Hysterosalpingogram (HSG)

The test is performed in an X-ray center under mirroring. During the test, a contrast agent is injected that fills the uterine cavity and, if there is no blockage in the fallopian tubes, the agent passes through them into the pelvis.

Sono-HSG

Sonohysterosalpingography is a diagnostic procedure in which sterile saline or a specialized foam is gently instilled into the uterine cavity and fallopian tubes. Filling the uterine cavity with fluid enables high-resolution imaging of the uterine lining, similar in quality to that achieved with hysteroscopy. This allows for the detection of intrauterine abnormalities such as adhesions and polyps.

An advanced version of the test includes 3D ultrasound imaging of the uterus, which helps identify congenital anomalies such as uterine septum, bicornuate uterus, and fibroids. The examination also includes an ultrasound evaluation of the ovaries to detect any abnormal findings.

Because this test does not require iodine-based contrast material, it is suitable for women with allergies to iodine or fish. Additionally, there is no exposure to radiation, making it a safer option for many patients. One of its most significant advantages is that the procedure is minimally invasive and nearly painless.

Diagnostic hysteroscopy

Hysteroscopy involves the direct visualization of the uterine cavity using a thin optical fiber connected to a camera and monitor. A normal uterine cavity is one that is free from abnormalities such as polyps, fibroids, septa, or adhesions—conditions that can reduce the likelihood of successful embryo implantation.

During the procedure, gas or fluid is gently introduced into the uterine cavity to expand it and allow clear visualization of its walls. Hysteroscopy can be performed either without anesthesia or under brief general anesthesia, depending on the individual case and patient comfort.

Surgical hysteroscopy

This procedure is performed when a problem has been identified within the uterine cavity that requires surgical intervention. It is typically carried out under anesthesia in an operating room setting.

Laparoscopy

Laparoscopy is a surgical procedure performed under general anesthesia in an operating room. After the abdomen is gently inflated with gas, a thin optical fiber connected to a camera and monitor is inserted through a small incision near the navel. This allows for direct visualization of the pelvic organs, including the uterus, fallopian tubes, and ovaries, as well as the detection of other conditions that may impact fertility.

If a treatable condition is identified during the procedure, additional small incisions may be made to insert surgical instruments, enabling immediate treatment or correction of the problem within the same procedure.

The clarification process for men:

Review of medical history

Physical examination

Relevant laboratory tests

Semen analysis and hormonal tests when required

In some cases of abnormal semen analysis, a scrotal ultrasound of the testicles should be performed

The semen analysis

A semen analysis provides key information about sperm health, focusing on three main parameters: concentration, motility, and morphology. The results of this test play a crucial role in determining the appropriate course of treatment.

During the consultation with Dr. Shlomi Barak, the findings are thoroughly reviewed, and a clear picture of male fertility is established. Based on these results, a personalized treatment plan is discussed and agreed upon.

Other Services Available at Our Clinic

Freezing eggs and embryos for fertility preservation

Egg or embryo freezing is performed for two main reasons:

medical reason

When a medical condition is identified that may compromise ovarian reserve or future fertility, fertility preservation is recommended. This typically involves retrieving eggs and either freezing them or creating and freezing embryos for future use when needed.

Social egg freeze

In 2011, a law was enacted in Israel allowing women aged 30 to 41 without a partner to undergo ovarian stimulation and an egg retrieval treatment for the purpose of freezing unfertilized eggs for future use.

It is important to note that egg freezing does not guarantee egg survival after thawing or the achievement of pregnancy. Since both the quality and quantity of eggs decline with age, it is advisable not to delay family planning when possible.

Endometrial Scratch – Enhancing Uterine Receptivity

This procedure involves the deliberate “scratching” of the uterine lining prior to treatment. The underlying assumption is that a healthy uterine lining will respond to this minor injury by increasing blood flow and releasing self-healing and regenerative substances into the area.

This response may enhance the endometrium’s ability to support embryo implantation during the subsequent embryo transfer cycle.

The decision to perform an endometrial scratch is made on an individual basis, depending on each patient’s medical history and fertility treatment plan.

Preimplantation genetic testing

PGD Preimplantation Genetic Diagnosis – PGT-M
PGS Preimplantation Genetic Screening – PGT-A

This procedure involves taking a biopsy from an embryo—either at the cleavage stage (around day 3, when the embryo has approximately 8 cells) or at the blastocyst stage (day 5–6). A single cell or a small group of cells is carefully removed and sent for genetic testing.

Only embryos found to be chromosomally or genetically normal are selected for transfer to the uterus.

PGT is commonly recommended in cases of:

Known genetic or chromosomal disorders in one or both partners
Repeated implantation failures
Recurrent miscarriages

This technique helps improve the chances of a successful pregnancy and the birth of a healthy child.

before beginning the treatment

Before beginning treatment, all relevant laboratory tests and an expanded pre-pregnancy genetic screening must be completed. Referral forms for these tests will be provided at the clinic. .
All administrative procedures must be arranged, such as: a parenting agreement signed by a notary attorney for an unmarried couple, a consent form for IVF treatments signed by both spouses, prescriptions and additional forms as needed.
You must purchase the medications needed for treatment in advance and ensure that you have all the prescriptions needed for continued treatment.
A man who is a candidate for sperm retrieval surgery will undergo all the tests necessary for the procedure.
When opening the file at the clinic, you will be asked to sign informed consent forms relevant to the procedure you are scheduled to undergo.
The clinic staff will guide you regarding the treatment plan and verify the validity of your general tests. If any test or form is missing, you will be asked to complete it before the start of treatment in order not to delay the start of your treatment.

the beginning of treatment

After all required tests for both partners have been completed, Dr. Shlomi Barak will determine the most appropriate treatment protocol. The selection of medications and their dosages will be based on the medical findings, the woman’s age, the underlying cause of infertility, and the response to any previous treatments.
Treatment begins with the ovulation induction phase, which aims to stimulate the development of multiple eggs in a single treatment cycle—compared to the natural cycle, which typically produces just one egg. This is achieved through hormonal stimulation, which encourages the growth of multiple ovarian follicles, each potentially containing a mature egg.
The daily dose of hormonal injections is carefully adjusted based on ongoing monitoring, including blood hormone levels and ultrasound scans, to assess the ovarian response. Additional medications are often used in combination to prevent premature ovulation, helping to ensure that eggs are not released before they can be retrieved.
When monitoring shows that the endometrial thickness, follicle size, and hormone levels indicate the presence of mature follicles, a trigger injection—containing either HCG (Ovitrelle) or Decapeptyl—is administered to induce final egg maturation. This injection is given approximately 34 to 35 hours before egg retrieval to ensure optimal timing for oocyte collection.
In certain cases, Dr. Shlomi Barak may recommend a natural cycle egg retrieval, which is performed without hormonal stimulation. This approach, known as a Natural Cycle, is typically considered for women who respond poorly to hormonal medications, have a low ovarian reserve, are of advanced maternal age, or have experienced multiple treatment failures. It focuses on retrieving the single egg naturally selected by the body during the cycle, with minimal intervention.
In cases of inappropriate ovarian response or concern for premature ovulation, the treatment cycle may be canceled and no aspiration will be performed.

As a general rule, there is no prohibition against having sex during treatment unless otherwise recommended.

Fertility medications

A wide variety of medications are used for in vitro fertilization treatments.

Ovarian Stimulation Medications

Gonadotropins

Medications such as Menopur, Puregon, Gonal-F, and Pergoveris act directly on the ovarian follicles to stimulate their growth. The goal of these medications is to recruit multiple follicles in each ovary while minimizing the risk of ovarian hyperstimulation syndrome (OHSS)—a rare but potentially serious complication.

These medications are administered under Dr. Barak’s supervision via subcutaneous injections in the abdominal area, allowing for self-injection at home with proper instruction.

Some medications are provided in pre-filled injection pens for ease of use, while others come in ampoules containing a powder and a separate diluent, which must be mixed prior to injection.
Before treatment begins, the clinic team will offer personalized training and guidance to ensure you feel confident and prepared to administer your specific medications.

Antiestrogens

Clomiphene, letrozole. They are given in pills and act indirectly on follicle development.

Medications that prevent premature ovulation

These medications work by temporarily and reversibly suppressing the hormone GnRH, which controls the release of FSH (follicle-stimulating hormone) and LH (luteinizing hormone) from the pituitary gland. By doing so, they help prevent premature ovulation before the scheduled egg retrieval.

In Israel, the medications used include:

GnRH agonists: Decapeptyl, Suprefact, Synarel
GnRH antagonists: Cetrotide, Orgalutran

Some of these medications are administered via subcutaneous injection, while others are delivered as a nasal spray. The specific medication and method of administration will be tailored to each patient’s treatment plan by Dr. Barak.

Medications to induce ovulation

Ovitrelle and Decapeptyl are medications used to trigger ovulation at the optimal time during treatment. They are administered by injection approximately 34 to 35 hours before egg retrieval, ensuring the eggs reach full maturity before collection

Hormonal Support for the Uterine Lining

After egg retrieval, medications containing the hormone progesterone are administered to support the uterine lining and enhance implantation.
These can be given in several forms:

Vaginal tablets or gel: Endometrin, Utrogestan, Crinone
Intramuscular injections: Prontogest, Progesterone Retard, Gaston
Oral tablets: Duphaston

In some cases, estrogen supplements—such as tablets or patches (Avorel, Estrophem)—are also prescribed to further support the endometrium.

The specific combination and method of administration will be tailored to each patient’s individual needs by Dr. Shlomi Barak.

Side effects from hormone therapy

As mentioned, the purpose of hormonal treatment is to either induce ovulation in women who do not ovulate or to stimulate the development of multiple eggs, thereby increasing the chances of pregnancy.

While these treatments are generally safe and well-tolerated, they may cause side effects and complications, including (but not limited to):

Bloating and abdominal discomfort
Mood swings or emotional sensitivity
Headaches
Breast tenderness
Mild pelvic pain
Temporary weight gain due to fluid retention
Risk of ovarian hyperstimulation syndrome (OHSS) in rare cases
Local skin reactions at the injection site

Dr. Shlomi Barak and the medical team will monitor you closely throughout the treatment to minimize risks and ensure your safety.

Although rare, some women may experience sensitivity or allergic reactions to hormonal preparations. In any case of unusual symptoms or unexpected side effects, it is important to notify the clinic staff immediately for appropriate evaluation and care.
Multiple pregnancy - Multiple pregnancy is a consequence of the number of embryos transferred to the uterus. The rate of multiple pregnancies (twins and triplets) in hormonal treatments is relatively high (up to 30%) depending on the type of treatment. Multiple pregnancies are associated with a higher incidence of gestational hypertension, gestational diabetes, preterm labor and premature birth, and consequently complications of prematurity.
Miscarriages and Ectopic Pregnancies - Pregnancies achieved through ovulation induction or fertility treatments may carry a slightly increased risk of miscarriage or ectopic pregnancy compared to natural conception.Dr. Shlomi Barak and the medical team will monitor early pregnancy closely to ensure prompt detection and management of any complications.
Ovarian torsion, rupture, or bleeding from the ovary - are relatively rare, but sometimes require surgical intervention.
Additional Considerations and Rare Complications - To date, no clear causal link has been established between ovulation induction and the development of ovarian cancer. In fact, pregnancy itself is known to reduce the long-term risk of malignant ovarian tumors. Following fertility treatments, there is a slight increase (1–2%) reported in the incidence of birth defects or genetic disorders. However, this may be related to the underlying cause of infertility rather than the treatments themselves. Dr. Shlomi Barak and the clinic team are committed to providing personalized care, including appropriate screening and counseling, to ensure the safest possible path to parenthood.

Ovarian Hyperstimulation Syndrome (OHSS)

Signs and symptoms of ovarian hyperstimulation syndrome:

Ovarian hyperstimulation syndrome is a potential complication of fertility treatments involving ovulation induction. It presents with a broad range of clinical symptoms and is driven by two main mechanisms:

Significant enlargement of the ovaries, due to the hormonal stimulation that leads to the recruitment of multiple follicles.
Increased vascular and membrane permeability, which causes fluid to leak from the bloodstream and accumulate in third-space compartments—such as the abdominal cavity, chest cavity, around the heart, and in subcutaneous tissues.

This fluid shift is the central cause of the complications associated with OHSS. As fluid leaves the blood vessels, blood volume decreases, leading to increased viscosity and a higher risk of blood clots. Additionally, patients may experience fluid and electrolyte imbalances, reduced urine output, and in severe cases, even kidney failure.

Symptoms and Severity

Mild OHSS is the most common form and occurs in 10–25% of cases. Symptoms include:
- Abdominal bloating
- Pelvic discomfort
- Ovarian enlargement and cyst formation
- Minor fluid accumulation in the abdomen
Moderate OHSS occurs in approximately 5–15% of cases and may include:
- Nausea
- Vomiting
- Diarrhea
- More pronounced abdominal pain
Severe OHSS is rare, affecting 0.1–5% of patients. In addition to the above symptoms, it may also involve:
- Shortness of breath
- Significant fluid buildup in the abdomen, chest, and around the heart
- Blood clots (due to hemoconcentration)
- Risk of embolism, heart failure, or kidney failure
- In some cases, hospitalization is required, and paracentesis (drainage of fluid from the abdomen) may be necessary

Management

In most mild cases, symptoms resolve on their own with rest and adequate hydration. Dr. Shlomi Barak and the clinic team monitor patients carefully during stimulation to minimize the risk of OHSS. In more serious cases, treatment may be delayed or stopped, and appropriate medical intervention will be initiated.

Before Egg Retrieval – Final Preparations

Ensure that all required tests and informed consent forms have been completed and submitted.
If donor sperm is being used, we recommend coordinating its transfer from the sperm bank at least one week prior to egg retrieval to avoid any delays in the process.
It is advisable to purchase all medications needed for the post-retrieval support phase in advance.
The day following the administration of the HCG (Ovitrelle) or Decapeptyl trigger injection is typically a rest day, during which no medications are required.
The clinic team will contact you with instructions for the procedure, which is scheduled to take place at Assuta Rishon LeZion.
The egg retrieval is performed approximately 35 hours after the administration of the trigger injection.

Egg retrieval day

Egg retrieval is typically performed under general anesthesia, except in rare cases. Therefore, it is essential that the patient is completely fasting for at least 6 hours prior to the procedure—this includes no eating, drinking, chewing gum, or smoking.
Egg retrieval is performed under the guidance of a vaginal ultrasound probe, allowing precise access to the ovarian follicles. Immediately after retrieval, the follicular fluid is transferred to the laboratory, where the eggs are identified.
Upon waking from anesthesia, the patient is informed of the number of eggs retrieved in real time.
Although egg retrieval is a routine and generally safe procedure, it is still considered minimally invasive, and complications are rare. In exceptional cases, there may be a risk of:
- Ovarian rupture
- Injury to a blood vessel, bladder, or intestine
In very rare instances, these complications may require surgical intervention. Dr. Shlomi Barak and the medical team take every precaution to minimize risks and ensure patient safety throughout the procedure.

Instructions for the Spouse / Partner

The partner must bring the sperm sample with an ID card for identification purposes.
Semen must be collected in a sterile container only—specifically, a urine culture cup available at any pharmacy. Before delivering the sample to the laboratory, please ensure that the container is clearly labeled with a sticker containing the full details of both partners to avoid any identification errors.
It is recommended to collect the semen sample at home and bring it to the clinic within 1.5 to 2 hours of collection. Please keep the container at body temperature during transport (e.g., in an inside pocket). Alternatively, a semen sample can be provided on-site in a designated private room at the clinic, if preferred or more convenient.
Before collecting the semen sample, it is important to wash your hands and genitals thoroughly to ensure the sample is clean and free from external contaminants.
Do not use soap or other lubricants other than baby oil/paraffin. Be careful not to get the oil into the sterile container.
Do not heat or cool the semen sample. Keep the container at room temperature and store it in a shaded area, away from direct sunlight or cold surfaces.
It is recommended to avoid sexual intercourse for at least two days prior to sperm collection, or as otherwise instructed by the clinic, to help ensure optimal sample quality.

Following egg retrieval

Following egg retrieval, the patient will remain under observation at the clinic for approximately one to two hours. It is normal to experience mild abdominal discomfort, light vaginal bleeding, and a sensation of pressure in the lower abdomen. However, if you experience any of the following symptoms in the hours after the procedure, please contact the clinic staff immediately or proceed to the nearest emergency room with your discharge letter:
- Severe or worsening abdominal pain
- Heavy vaginal bleeding
- Feeling faint or lightheaded
- Difficulty breathing
- Fever
- Excessive abdominal swelling
- Any other unusual or concerning symptoms
Your safety is our top priority. Please do not hesitate to reach out with any concerns.
Vaginal Bleeding After Egg Retrieval - Light vaginal bleeding following egg retrieval is common and typically not a cause for concern. This bleeding does not originate from the uterus, and therefore is not considered post-procedural uterine bleeding. Instead, it usually results from minor irritation or injury to the vaginal wall caused by the ultrasound-guided needle during the procedure.
Important: Driving is prohibited for at least 6 hours following egg retrieval under anesthesia. Please plan your transportation in advance and ensure that a responsible adult accompanies you home.

In the Days Following Egg Retrieval

Post-Retrieval Update - The day after egg retrieval, the patient and her partner will receive important updates, including:
- The number of eggs that successfully fertilized
- The planned date for embryo transfer
- Any necessary adjustments to the medication regimen
This information will help guide the next steps in the treatment process and ensure optimal preparation for embryo transfer.
Progesterone Support After Egg Retrieval - Two days after the egg retrieval, treatment with a progesterone preparation (tablets or vaginal gel) should begin, following Dr. Barak’s instructions, and continue until the pregnancy test is performed. If the pregnancy test is positive, progesterone support should be continued as directed by the clinic staff to help maintain a stable environment for early pregnancy.
Hydration After Egg Retrieval - In the days following egg retrieval, it is important to drink plenty of fluids—approximately 1.5 liters per day—to support recovery and reduce the risk of complications such as ovarian hyperstimulation syndrome (OHSS).
You may be asked to take additional medications following your egg retrieval (antibiotics, etc.).
If necessary, you can take painkillers (such as paracetamol or Optalgin) if you are not allergic to the medication.
If you feel well, it is recommended that you return to work and your normal daily routine the day after egg retrieval.
Embryo Transfer - The embryo transfer will take place 2 to 5 days after egg retrieval, according to Dr. Barak’s personalized treatment plan. The timing depends on the development stage and quality of the embryos.
When to Seek Medical Attention
If you experience any of the following symptoms after treatment, please contact the clinic immediately or proceed directly to the emergency room:
- Severe abdominal pain
- Feeling faint or lightheaded
- Difficulty breathing
- Fever
- Marked abdominal swelling
- Any other unusual or concerning symptoms
Prompt evaluation is important to ensure your safety and well-being.

Embryo Transfer and What to Expect Afterwards

Timing of Embryo Transfer
Embryo transfer can be performed at different stages of development, depending on individual circumstances and the treatment plan:
- On the second day after egg retrieval, when the embryo typically consists of 2–4 cells
- On the third day, when the embryo has developed to 6–8 cells
- On the fifth day, when the embryo reaches the blastocyst stage, containing approximately 100 cells
The decision regarding the timing of the transfer is made by Dr. Shlomi Barak in coordination with the embryology team, based on the quality and development of the embryos.
The timing of the embryo transfer and the number of embryos to be transferred will be determined by Dr. Shlomi Barak, based on several important factors, including:
- The quality and developmental stage of the embryos
- The woman’s age
- The number of previous treatment cycles
- Additional individual medical considerations
This personalized approach aims to maximize the chances of success while minimizing potential risks, such as multiple pregnancies.
For the embryo transfer or thawed embryo transfer procedure, it is required that you attend with your partner. In cases where your partner is unable to be present, you must provide a Power of Attorney for the Number of Embryos to Be Transferred.
This document must:
- Be signed by you in the presence of the designated signatory
- Be valid for one year
- Be completed in advance, usually at the time of signing consent forms at the clinic
This ensures compliance with legal and ethical requirements surrounding shared decision-making in fertility treatment.
The partner is welcome to be present in the room during the embryo transfer, depending on the couple’s preference.
The procedure is performed without anesthesia and is typically painless. A thin, flexible catheter is gently inserted through the cervical canal into the uterine cavity, where the embryos are carefully placed under ultrasound guidance. This simple and precise process usually takes only a few minutes and does not require recovery time.
The procedure will usually be performed when the bladder is full, so it is recommended not to empty the bladder for about two hours before the procedure, unless otherwise recommended by the clinic staff.
After the embryo transfer, Dr. Barak and the clinic team will provide you with updated instructions for continuing your medication regimen, tailored to support the implantation process and early pregnancy development.
If, following the embryo transfer, there are any high-quality surplus embryos, they will be frozen (cryopreserved) for potential future use, in accordance with your treatment plan and consent.
Important Information About Embryo Freezing - It is important to understand the following:
- Not every treatment cycle results in embryos suitable for freezing
- Not all embryos meet the quality criteria required for successful freezing
- Not all frozen embryos survive the thawing process, although survival rates are generally high with modern techniques
  The decision to freeze embryos will be made in accordance with Dr. Barak’s professional assessment and based on the quality and development of the embryos.
Following embryo transfer, embryo freezing, or egg freezing, a personalized laboratory report will be generated. This report includes detailed information about the freezing process—such as whether embryos were frozen, the number frozen, and on which day of development. The report is available through the “Assuta Personal” portal on the Assuta website.
To access it:
- Visit the Assuta website
- Log in using your mobile phone number and ID number
- You will receive a personal access code via SMS to securely view your report
This ensures easy, secure access to your medical information at any time.
Light spotting or mild bleeding is common in the days following embryo transfer and can also occur in early pregnancy. While this is usually not a cause for concern, you are welcome to contact the clinic staff for guidance or reassurance regarding any symptoms you may experience.
Important: Do not stop the support before the date of the pregnancy blood test without receiving explicit instructions from Dr. Barak. (Even if bleeding has begun).

Together, we will find a personalized solution that's right for you.

For a consultation with Dr. Barak, leave your details and we will get back to you as soon as possible.

Meet Dr. Shlomi Barak

Director, Multidisciplinary Center for Female and Male Fertility
Director, Fertility and IVF Unit, Assuta University Hospital – Ashdod

Dr. Shlomi Barak is a specialist in obstetrics and gynecology, with advanced expertise in female fertility and IVF, and a super-specialty in andrology, male fertility, and microsurgery.

He brings extensive international experience, having led one of Australia’s largest and most successful fertility clinics, renowned globally for its excellence in female fertility, IVF, male infertility, and second-opinion consultations for women with low ovarian reserve.

In addition to his clinical work, Dr. Barak is actively involved in clinical and basic science research and has published dozens of peer-reviewed medical articles.

His guiding principle is a commitment to personalized care, combining creative thinking with innovative, evidence-based treatments tailored to each patient’s unique needs.

We do everything we can to ensure you have the highest chance of success.

patient empowerment

At our center, patients are full and active partners in the medical process and in decision-making throughout. We are committed to partnership and full transparency, and in our eyes, they are an integral part of successful treatment.

Personalized treatment

We believe in personalized care that is precisely tailored to the patient's journey so far and to provide a comprehensive response to their needs and concerns.

Support envelope

A skilled and professional team is at the disposal of patients, including special personal support in complex cases. For us, a sensitive and compassionate envelope of support is an integral part of the service and care we provide.

Progress and innovation

The center operates in ongoing collaborations with leading centers in Israel and around the world in the field of fertility. We are up-to-date with all the latest scientific and technological innovations and developments in the field.