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Assisted reproduction/ Test-tube treatment / In-vitro fertilization (IVF)

When can IVF treatment be offered?

  • When the woman has closed or damaged fallopian tubes as a result of pelvic inflammatory disease or appendicitis, previous caesarean section or operations in the stomach
  • In connection to reduced sperm quality
  • In the event of endometriosis (“chocolate” cysts or “blood” cysts)
  • In the event of unexplained infertility (all examinations are normal for both the man and the woman)
  • When the woman or the man has been sterilised
  • In the event of unsuccessful insemination with partner’s sperm or donor sperm
  • In the event of unsuccessful hormone stimulation or insemination of women with hormonal disorders (PCO)
  • When the woman hasn’t reached the age of 46 (cf. legislation on assisted reproduction)
  • When the woman is single or lesbian

Preliminary consultation for women/couples that are to be treated by IVF

If you’ve previously undergone treatment for infertility at a hospital or another fertility clinic, either public or private, it’ll be of benefit if you can obtain a copy of your medical records and submit them to us prior to the preliminary consultation so that we can acquaint ourselves with your medical history and plan the best possible treatment.

If you’ve previously undergone IVF treatment, we’d also very much like to see the previous embryo development records.

At the consultation we’ll obtain medical records of you and discuss with you which type of treatment you want and what you can expect of such a treatment. An ultrasound scan of the uterus and ovaries will be performed, with a plan subsequently being drawn up for your treatment.

We’re very focused on adapting the treatment to each individual patient/couple and tailoring a treatment that precisely suits you.

When can we begin treatment?

You can choose yourself when you want treatment to begin. Usually, you can begin treatment immediately after the preliminary consultation.

Test for infectious diseases and vaccinations

According to the Danish Tissue Act, all patients undergoing IVF treatment must be tested via a blood sample for Hepatitis B and C, and AIDS (HIV 1 and 2). If you’ve previously had these blood tests taken, please bring a copy of the results. Your name, civil registration number (birth date), exact tests, laboratory and date of the blood test must appear in the results. The blood tests may not be more than two years old. If you haven’t been tested before, we’ll take the blood tests at the first consultation. Prior to beginning treatment we must have the results of the tests, which must be negative. The results are usually ready within a week.

It’s important that the woman has either had or has been vaccinated against German measles at least three months prior to beginning treatment. If you work with young children, it can also be a good idea to be tested for slapped cheek syndrome.

We primarily use two different methods of treatment

A. Long treatment with down-regulation

B. Short antagonist treatment

Re. A. The advantages of the long treatment is that it provides the greatest number of uniform eggs and thereby also the highest number of useful eggs for subsequent embryo transfer and implantation. It’s easy to schedule, as the preliminary treatment of the ovaries with nasal spray/injection, as part of down-regulation, can be prolonged by a few extra days, and, as such, scans, egg retrieval, etc., can be planned in good time based on the woman’s/couple’s wishes. The disadvantage is that some women suffer from side-effects of the down-regulation (this is described in more detail in a later section).

Re. B. The advantage of the short treatment is that it doesn’t take much time and there’s NO preliminary treatment with nasal spray/injection, thus enabling the woman to avoid any potential side-effects. The disadvantage is that it can give fewer eggs, more of which are immature, which means that the total number of useful eggs may be reduced in comparison with the long treatment. It‘s more difficult to plan, as the start of treatment depends on the woman’s menstrual cycle, with treatment beginning just 2-4 days after the onset of menstruation. The method is recommended, in particular, for young fertile women where the man has reduced sperm quality or for women with few eggs. This treatment is becoming more and more popular due to the many advantages.

A – Long treatment:

The long treatment begins with down-regulation from around the 21st day of the menstrual cycle. This is calculated on the basis of the length of your cycle. Down-regulation can be taken both as a nasal spray 3-4 times per day or as a daily injection. The type of down-regulation is agreed with the nurse.

In the event of an irregular or short cycle, we recommend that contraceptive pills are used at the onset of bleeding, as this will enable us to calculate exactly the right time to begin down-regulation.

Registration for treatment:

You register for treatment on the first day of bleeding. This is the day on which you have real bleeding from morning to evening, i.e. not spotting.

You can either call us on +45 76 24 50 20 from 9.15-12.00 or 12.30-14.30, or send us a mail. We usually respond the same day. In the event that bleeding starts at the weekend, just send us a mail.

You’ll then get an appointment for the first scan, which will be on around the 21st day of your menstrual cycle.

B – Short treatment:

The short treatment primarily follows your own menstrual cycle. You begin hormone injections on the second full day of bleeding. As a rule, we see you at the end of the cycle prior to starting up. We perform an ultrasound scan of your uterus and ovaries in order to ensure that everything looks good prior to beginning treatment.

You’ll get thorough instructions concerning injection technique of the hormone by the nurse, as well as an explanation of the treatment schedule. You’ll be given a personal treatment chart which you must follow.

 

Registration for treatment:

You register for treatment on the first day of bleeding. This is the day on which you have real bleeding from morning to evening, i.e. not spotting.

You can either call us on +45 76 24 50 20 from 9.15-12.00 or 12.30-14.30, or send us a mail. We usually respond the same day. In the event that bleeding starts at the weekend, just send us a mail.

You’ll then get an appointment for the first scan, which will be on around the 7th day of your menstrual cycle.

You should expect to meet at the clinic on the following days:

21st day of your cycle (start up of down-regulation)

During the first meeting at the clinic we’ll carry out an ultrasound scan of the uterus and ovaries in order to ensure that it’s the optimal point in time to begin down-regulation.

The nurse will give you an introduction to administering the nasal spray or injection for down-regulation. The down-regulation must be taken for around 14 days.

When using the nasal spray this must be administered 4 times per day at equally spaced intervals while you’re awake. No more than 8 hours may elapse between each spray (night time). It’s a good idea to switch between nostrils. If you forget a spray, it should be taken as soon as you remember it, or just take two doses next time.

With regard to the daily injection, this must be taken at around the same time every day.

Effect of down-regulation

Primary treatment with down-regulation prevents the production of sex hormones FSH and LH by the pituitary gland, thus reducing the risk of ovulation before the eggs are mature and can be removed. It’s therefore important to continue down-regulation in parallel with subsequent hormone stimulation, although in a reduced dose. In total, the down-regulation medicine must be taken for 3-4 weeks.

Side-effects during down-regulation

Side-effects are relatively rare, but can consist of headaches, tiredness, hot flushes, nausea and irritability.

The side-effects can be minimised by drinking plenty of fluids and getting a good night’s sleep. Headaches can be alleviated with Panodil 500 mg (2 tablets max x 4 daily).

Menstruation

Your menstruation will often begin within the first 10 days of commencing down-regulation, but may be late. Bleeding can be more prolonged than normal or can be followed by spotting for a couple of days. This is completely normal.

If you haven’t had menstruation prior to the scheduled time, you must contact the clinic. We then need to slightly reschedule your treatment plan.

This has no significance for the final outcome.

1st stimulation day (start up of hormone injections)

Only in certain cases is it necessary to attend the clinic on this day.

We’ll carry out an ultrasound scan of the uterus and the ovaries in order to ensure that everything’s as it should be prior to starting hormone stimulation. Some women will still be bleeding, which is no hindrance for a scan or commencing hormone treatment.

The nurse will provide instruction in injection technique of the hormone and explain the next steps of the plan up until the next meeting at the clinic. This will also appear on your personal treatment chart.

Effect of the hormone injections

The hormone injections are made up of an egg-stimulating hormone (FSH), which promotes the production of more than the one egg that women otherwise produce each month.

Side-effects of the hormone injections

The daily hormone injections can result in slight tenderness around the injection sites. Some women can become bloated in the abdominal region, in particular towards the end of the stimulation. This is due to the growth of the ovaries due to the many eggs. Headaches and tiredness can also occur.

You DON’T put on weight as a result of the hormone treatment, but fluid can accumulate in the body which will be expelled again once the treatment is complete.

9th stimulation day (measurement of the size and number of the follicles)

Attend the clinic. You’ll receive an ultrasound scan, in which we can see the effect of the hormone injections. We measure the size and number of follicles. If they aren’t big enough, we’ll book a new time for a scan, which will often take place 2-3 days later.

If possible, we plan the time of egg retrieval on this day. The nurse will go through the onward process in detail and plan when the ovulation injection has to be taken, such that you feel comfortable about the upcoming treatment.

REMEMBER to take the ovulation injection precisely as instructed, as otherwise we won’t be able to retrieve the eggs.

You may experience stomach pains and the feeling of ovulation the day after you’ve taken the ovulation injection. This is completely normal.

Egg retrieval

You must meet at the clinic at the appointed time. Egg retrieval is carried out in the morning. It’s a good idea to have eaten breakfast, as this reduces the risk of feeling unwell due to your blood sugar level being too low.

Most women take a sedative 2 hours prior to egg retrieval (provided by us). This pill helps to calm the nerves. Furthermore, we also recommend that you take 1g Panodil/Pamol/Pinex concurrently with the sedative.

Your bladder must be empty on this day.

We begin by giving a local anaesthetic in the vagina and inserting a hypodermic needle into your elbow joint for Fentanyl, which is a fast-acting, pain-relieving morphine drug. We then empty the follicles one at a time. The vast majority of women experience egg retrieval as being completely without drama, and it’s very important for us that it’s a good experience.

Following the procedure, you’ll be tired and perhaps a little tender in the abdominal region. You’ll be given a bed to lie in until you feel well enough to go home.

Owing to the pain-relieving medication, you must NOT drive a vehicle during the first 24 hours. You may experience an increase in pain in your stomach in the evening and the following day, after which the pain should subside. This is completely normal, but if the pain is accompanied by feeling poorly in general, you should contact either us (emergency phone no.: +45 3115 1505) or the doctor from the emergency services.

Semen sample

A semen sample can be taken at home or here at the clinic (in the “gentlemen’s room”). This will be agreed at the final scan prior to egg retrieval. The semen sample mustn’t be more than one hour old.

There mustn’t be any ejaculation during the last 2-3 days before the semen sample is taken, although we don’t recommend more than 5 days’ abstinence.

The day after egg retrieval you’ll begin progesterone treatment (Crinone/Lutinus). This can result in a bloated feeling and menstruation-like discomfort.

In the event of short treatment, this is also begun with 2 Østradiol tablets per day.

Embryo transfer

After 2-6 days an egg is implanted in the uterus. The best egg is chosen for transfer and the rest of the eggs remain in the laboratory for a total of 5-6 days, where they continue to develop. The eggs that are deemed to be able result in pregnancy (blastocyst) are frozen for later use.

REMEMBER to make sure that your bladder is HALF-FULL prior to egg retrieval.

The actual embryo transfer is a quick procedure and doesn’t usually involve any discomfort.

You can subsequently live your life as normal and there aren’t any restrictions in terms of work.

We advise against hard physical training and sexual intercourse for the first week after embryo transfer.

You’ll receive a date on which the pregnancy test should be taken, and in the weeks up to the test we’ll all be crossing our fingers for a positive outcome.

WELCOME to IVF-SYD

Description of the treatment:

You begin the hormone injections on the second full day of bleeding, as agreed at the last meeting. Take these injections continuously until the first scan, which will be on around the seventh day.

An ultrasound scan will be carried out in order to see the size and number of the follicles. We also assess here the commencement of the hormone that prevents ovulation (Orgalutran/Cetrotide/Fyremadel).

If necessary, we’ll perform a new scan after 2-3 days, otherwise we’ll plan the egg retrieval on this day.

You’ll get a thorough description by the nurse of the next steps of the course of treatment in order to help you feel comfortable.

The point at which you take the ovulation injection will be planned.

REMEMBER to take the ovulation injection precisely as agreed, otherwise we can’t retrieve the eggs.

You may experience stomach pains and the feeling of ovulation the day after you’ve taken the ovulation injection. This is quite normal.

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Fertilitetsklinik IVF-SYD
Skærbækvej 4
DK-7000 Fredericia

Tlf.: +45 76 24 50 20
E-mail: info@ivf-syd.dk

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