Effective, safe treatment, education, research,
exchange of knowledge and patient satisfaction represent our key aims and
objectives. Meeting these are of high priority, and this is reflected in our
policies for hiring new employees or planning activities.
Treatment
The Fertility Clinic places great importance on providing
the highest quality of infertility treatment. It is essential to us that the
treatment is planned based on the couple’s individual needs. Through continuous
and detailed exchange of information, the couple can influence and share
reponsibility for their treatment pathway
Education
Our staff members are encouraged and expected to maintain
and develop their knowledge and skills by a programme of ongoing education, both
internal and external.
Treatments offered
Insemination with sperm from partner or donor
Insemination
with sperm from the partner is called IUI-H (Intrauterine insemination with
homologous semen)
Insemination with sperm from donor partner is called IUI-D (Intrauterine
insemination with donated semen)
The purpose of insemination is to increase the pregnancy rate by optimizing
the number of living sperm cells in the fallopian tubes at the time of
ovulation.
- The ovaries are gently stimulated with hormones, with the aim of maturing
one or two follicles.
- The development of follicles is monitored by vaginal ultrasound scans.
- When the follicles are mature, ovulation is triggered by a specific hormone
injection.
- Insemination is performed 36-40 hours after the ovulation
injection
Insemination can be used if:
- There is a need of donor sperm
- The cause of infertility is unknown, meaning there is a normal sperm count,
the fallopian tubes are not blocked, and regular ovulation takes place.
- Infertility is caused by a slightly reduced sperm quality.
- There is mild endometriosis.
- In case of ovulation disorders which for example, can commonly occur in
women with PCOS.
Treatment with IUI implies:
Patent, open fallopian tubes, viewed by passage of fluid on X-ray or water
scan.
Treatment Plan
At the first visit to The Fertility Clinic, a
treatment plan will be made in consultation with a
physician.
Registration for treatment
On the first day
of your menstrual period you call the clinic and register with the
nurse.
The nurse will return your call the same day and arrange for the
first ultrasound /scan. The day of the first ultrasound scan depends on the
treatment plan and the length of your cycle.
IUI treatment
Stimulated cycle:
A mild hormonal stimulation is given as injections with FSH (follicle stimulation hormone).
The development of the follicles is monitored by ultrasound scans and the
injection to trigger ovulation is given when the largest follicle is
mature.
During hormone stimulation, more than one follicle may develop
and you may ovulate spontaneously. Whilein most cases, only one egg will be
fertilized, on occasion more eggs may be fertilized. There is therefore an
increased risk of multiple pregnancy when hormonal stimulation is used. However,
this risk is small (around 5 % of pregnancies). If we consider that there is a
risk of triplets, the cycle will be cancelled.
Medication and possible side effects
Gonal-f ® or Menopur ®
FSH
hormone which stimulates the growth of the follicles; it is given as injections
in the skin below the navel.
Side effects: Brief pain and tenderness at
the injection site, breast tenderness, fatigue and
bloating.
Ovitrelle ®
HCG Hormone (used for triggering
ovulation), induces ovulation after 36-40 hours; it is given by injection in the
skin below the navel.
Side effects: Brief pain and tenderness at the
injection site, fatigue, nausea, headaches and bloating.
The sperm test
If donor sperm is used, you wil get further information in the Fertility
Clinic.
If husband sperm is used, and the sperm sample is collected at home, it
must be delivered to the Fertility Clinic within one hour. The
sperm sample must be kept near the skin during transportation to maintain the
correct temperature. If this is likely to be difficult, , there are special
facilities for the sperm sample to be produced at the Fertility Clinic.
On the day of the insemination, a sperm sample must be delivered to the
Fertility Clinic's sperm laboratory by 8 am. We recommend that you refrain from
ejaculation one day before the sperm test
The sperm sample is delivered
in a cup supplied from the clinic. You will be asked to write your names and CPR
numbers on a label. The label must be put on the cup before delivering it to the
sperm laboratory.
Sperm is very sensitive to inflammation and body temperature rises. It is
very important that the man, prior to treatment, advise us of any illnesses
within the last three months.
When does insemination take place?
Insemination take place
approx. 36-40 hours after the ovulation induction injection is given.
This
procedure is simpler if you have a full bladder, so you will be asked to refrain
from urinating approximately two hours before insemination.
The number of
follicles growing in the ovaries will be monitored by regular ultrasound scans
and the thickness of the lining of the womb (the endometrium) will be
measured.
Then, a speculum is placed into the vagina, so that the cervix
(neck of the womb) can be seen. After lightly wiping the cervix, a thin, soft
plastic catheter is inserted through the cervical canal, where the prepared
sperm is injected into the uterine cavity.
The sperm will swim into the
fallopian tubes, where fertilization normally takes place.
The procedure
is usually without discomfort and takes only a few moments. Occasionally, there
may be a brief, period-like, pain. If this is your first insemination, we
recommend that you sit/rest in the waiting room for 15 minutes after the
treatment. Rarely, some women may feel uncomfortable the first time.
If
you have been inseminated before without problems, you can go home immediately
after insemination/treatment.
Recommendations after
insemination
Intercourse is permitted.
Avoid taking a bath or swimming
the day after insemination as there is a small risk of infection.
There are
no additional precautions and you are encouraged to live life as normally as
possible. You can exercise, go to work and do all the things you normally would
do.
Pregnancy Test
17 days after
insemination, you meet at Herlev Hospital, for an blood sample pregnancy test.
Even if you have started to bleed, a pregnancy test should still
be taken, as there remains a chance of a positive pregnancy test.
Pregnancy Result
It is
important that you call us to get the result of the pregnancy test, later the same day or the next day,
whether you think the test is positive or negative.
If the test is positive, an
appointment for a pregnancy scan/ultrasound will be made for three weeks later.
If you begin bleeding or experience abdominal pain in those three weeks, please
contact us.
Often, these symptoms indicate that the pregnancy is perishing in
a natural way. Rarely however, the pregnancy may be located in the fallopian
tube. If this is the case, it is very important to know since the embryo can
invade through the tube and lead to serious bleeding in the abdominal
cavity.
If the urine test is negative, you will be asked
to follow the previously made plan.
Who is responsible for the
treatment?
The doctor is always responsible for the treatment and the
treatment plan, made in collaboration with the nurses.
The nurses perform the treatment with scans and inseminations.
How many treatments are
offered?
For insemination with the husband's sperm, three attempts are
usually offered. If artificial insemination with donor sperm, six attempts are
usually offered. When FSH hormone is given, treatment can continue each month without a break
inbetween.
After each insemination, you will be informed
about the plan for the next treatment. This does not mean that we do not think
it will succeed. However, it is our experience that many couples are happy to
have a plan.
In vitro fertilization
In vitro fertilization is also known as IVF.
ICSI
stands for intra-cytoplasmic sperm injection, a means of IVF, fertilizing the egg
when very few sperm cells are available.
We normally offer 3 IVF treatments (with ICSI if
necessary) with transfer of fresh embryos. If you have any “spare” embryos
suitable for freezing/of a good quality, we can/will freeze and store the
embryos for transfer at a later time.
The principles of IVF in
brief:
The ovaries are stimulated with hormones (FSH) to develop an
appropriate number of mature eggs.
Under local anesthesia, the follicles are
emptied by a needle which is passed through the vagina into the ovary under
ultrasound monitoring.
The eggs are then fertilized in the
laboratory.
One or two embryos are returned (transferred) to the womb via a
soft catheter through the cervical canal.
We use different stimulation
treatments. Here we will described the two most common:
The
long protocol, ‘Chart 3’
The short protocol, ‘Chart 4’
Besides the
two most commonly used protocols, we also use a number of other treatment
protocols, if this is justified by the results of previous treatments (treatment
in this clinic, but also treatment from/in other clinics).
When you start
the treatment, you will receive a copy of the stimulation form.
The long protocol, Chart 3
On
the first day of your menstrual period you call us to register for treatment and
get an appointment (to start the treatment) approximately 21 days later.
Around day 21 of your cycle you will attend the
Fertility Clinic as planned.
The individual stimulation plan is made; if
necessary, preceded by an ultrasound.
Prescriptions for the medication for
this treatment will be handed to you.
The treatment is reviewed by a nurse,
who will provide you with the necessary syringes and relevant guidance.
The
treatment then begins with what is called the downregulation period. This phase
of treatment involves
· Gonapeptyl 0,1 mg daily. It will be given as an
injection under the skin, below the navel the next 2-3 weeks, or
· Nasal
Spray (Synarela ®). 3 puffs daily, then 1 puff every 8 hours for 2-3
weeks.
During this period you will probably menstruate.
After the 2-3 week down regulation period you
will start follicle stimulation treatment.
On day 1 of the stimulation period, we will
perform an ultrasound scan of the ovaries and the endometrium. This should now
be thin as a result of the menstruation during the down regulation treatment. We
also check that no ovarian cysts have developed.
From this day and the
following (approximately) 7 days you will receive an injection every day with a
FSH hormone which stimulates the follicles growth.
The treatment with the
down regulating hormone continues. The dosage, 0,1 mg Gonapeptyl or 2 sprays
Synarela a day is given until the day you get the ovulation-triggering
injection.
Day 8, approximately:
A further ultrasound scan is
performed to monitor and observe the number and size of the follicles.
A plan
for you is now made. Sometimes,you can plan already at day 8 when the eggs can
be collected. However, usually you will need a few more days of hormone
treatment, before the eggs are mature enough to collect. We will need to monitor
the follicles every other day at this stage.
Day x: The Ovulation trigger
injection.
Day x indicates the day which, in most cases, you will take
the ovulating hormone (Ovitrelle ®) at 10.00 PM. It is usually either day 9, 10,
11 or 12 - the same day you stop taking FSH.
The down regulating medicine is
agreed on individually.
Day x + 2: Egg collection:
Approximately
34-38 hours after ovulation injection, the eggs are collected and then
fertilized in the laboratory.
Day x + 4-7: Embryo transfer:
After
another 2-3 or 5 days, 1-2 fertilized eggs are transferred to the uterine
cavity.
We recommend that the bladder is not completely empty during embryo
transfer. Try to refrain from urinating two hours before
transferring.
Day x + 4: progesterone:
The day after the egg
collection you start treatment of the endometrium with a progesteron hormone:
Lutinus ® or Crinone ®
Progesterone is taken for 15 days or until the
pregnancy test
The short protocol, chart
4
You
will register on the first day of your menstrual period
Day 2-3:
Stimulation period begins on the second or third day of bleeding:
An
ultrasound is performed.
You will, from this day, take one daily FSH hormone
injection to stimulate the follicle growth.
From 5 day, you must also take
Orgalutran ® or Cetrotide ®, 0.25 milligrams once a day, which prevents
ovulation.
Day 8, approximately:
Renewed ultrasound to monitor the
follicles growth.
A plan for you is now made.
Sometimes, you can already plan at day 8 when the eggs can be collected. However, most times you will need
a few more days of hormone treatment before the eggs are mature enough to be
collected. We will need to monitor and observe the follicles every other day.
Day x: The Ovulation injection.
Day x
indicates the day which, in most cases, you will take the ovulating hormone
(Ovitrelle ®) at 10.00 PM. It is usually either day 9, 10, 11 or 12 - the same
day you stop taking FSH.
The down regulating medicine is taken last time on the day of Ovitrelle.
Day x + 2: Egg aspiration:
Approximately 36-40 hours
after ovulation injection, the eggs are collected and then fertilized in the
laboratory.
Day x + 4-7: Embryo transfer:
After another 2-3 or 5 days,
1-2 fertilized eggs are transferred into the uterine cavity.
It is an
advantage if the bladder is not completely empty during embryo transfer. Try to
refrain from urinating two hours before transferring.
Day x + 4:
Progesterone:
The first day after the egg collection you start treatment of the
endometrium with a progesteron hormone: Lutinus ® or Crinone ®
Progesterone
is taken for 15 days.
Pregnancy Test
16 days
after oocyte pick up/egg collection, a blood sample for pregnancy test is taken.
Even
if you have started to bleed, a pregnancy test should still be taken, as there
remains a chance of a positive pregnancy test.
Pregnancy Result
It is
important that you call us later the same day, to get the result.
If the
test is positive, an appointment for a pregnancy scan/ultrasound will be made
for three weeks later. If you begin bleeding or experience abdominal pain in
those three weeks, please contact us.
Often, these symptoms indicate that the
pregnancy is perishing in a natural way. Rarely however, the pregnancy may be
located in the fallopian tube. If this is the case, it is very important to know
since the embryo can invade through the tube and lead to serious bleeding in the
abdominal cavity.