Insemination treatment - IVF or Insemination in Danish Fertility Clinic

Insemination treatment
Insemination treatment
Why insemination treatment?
During the insemination procedure, the sperm cells
are flushed into the uterine cavity. This procedure
shortens the distance the sperms have to migrate
through the uterus and fallopian tube. Therefore, the
number of living sperm cells reaching the oocyte is
increased approximately 100 times in comparison with
a conventional intercourse.
By adding a low dose of FSH, the woman produces
two follicles, and the chance of pregnancy is twice the
chance of pregnancy with a single follicle. You have to
keep in mind that the presence of two follicles entails
a small risk of a twin pregnancy.
By inducing ovulation 36 hours before the planned insemination, we try to time insemination to take place
shortly before ovulation; the moment with the highest
chance of resulting in a pregnancy.
Insemination with partner sperm
When the menstruation begins
The woman has to make an appointment with her
gynaecologist for a basal ultrasound scan on cycle day 2
or 3 before the hormone treatment is started.
Why ultrasound?
By using vaginal ultrasound, the gynaecologist is able to
measure the thickness of the endometrium and the size
and number of the follicles within the ovaries. This measurement is necessary for assessing the optimal time
of ovulation induction.
2nd - 3rd day of the cycle, first ultrasound
examination
This basal examination is necessary to ensure that no
cysts are present in the ovaries. Now hormonal stimulation begins with
* Pergotime (Clomiphene) tablets or
* FSH injections (Puregon , Gonal-F or Menopur)
These drugs increase the levels of FSH in the blood and
stimulate follicle growth .
Cycle day 8-10, second ultrasound examination
A second scan on cycle day 8-10 is required to
measure the follicle size and the endometrial
thickness. The largest diameter of the follicle is
measured, and the diameter at the right angle (90 degrees) in relation to the first measurement. The
average of the two measurements represents the follicle size. Based on these measurements, the gynaecologist calculates when the follicle will measure 18 mm
and be ready for ovulation induction.
Insemination without ultrasound monitoring
In case you do not have the possibility to have ultrasound examinations, you can also determine your
ovulation using a urinary LH test. Once the test is positive, please call the clinic on phone +45 3834 9030. The
insemination takes place the day after the positive test.
After you have called, you induce ovulation by injecting
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the ovulation inducing substance (Ovidrel, Pregnyl) to
trigger the ovulation just for the sake of safety.
If you expect the positive LH test on a Saturday,
we recommend that you have an ultrasound
examination on the Thursday, so you can induce
ovulation earlier. We do not inseminate on Sundays.
measure 18 mm on average, you call the clinic directly on phone no. +45 3834 9030 to plan the insemination two days later.
The ovulation induction is injected 36 hours before the
planned insemination.
Ovulation is triggered
Ovulation is timed by injecting an ovulation-inducing
drug (Ovidrel, Pregnyl). Injection of this hormone causes ovulation to occur 38-42 hours later. Insemination
is planned to take place 36 hours after the injection,
shortly before ovulation.
According to Danish Law, not more than a maximum
of 3 follicles larger than 14 mm are allowed on the day
of ovulation induction, otherwise the insemination
is cancelled due to the increased risk of triplets!!!
The semen sample
On the day of insemination, the man must produce a
semen sample. Most men prefer to do this at the hotel
and bring it to the clinic on the morning of the insemination. You will receive a special cup for the sample.
Remember to write both your full names on the label.
The man should avoid ejaculation the last two
days before the scheduled insemination. The sample
must be kept warm during transportation and should
not be older than 3 hours at delivery.
Once you know when the largest follicle will
Sperm cells are very sensitive
to increased temperatures and
infections. Therefore, illness
and fever can affect the sperms
ability to fertilize an oocyte for
up to 90 days after the incident.
The insemination
The woman is placed in the gynaecological couch.
An ultrasound scan is performed to see whether
ovulation has already occurred and to count
the number of follicles. Afterwards, a thin catheter is
guided through the cervix into the uterine cavity
and the sperm cells are flushed into the uterus
and the fallopian tubes. Normally, this procedure
is painless. The woman rises from the couch after the
procedure and can leave the clinic immediately
afterwards. This procedure requires no special
precautions to be taken afterwards.
What about sex?
You can have normal intercourse during the
entire period of treatment. Actually, intercourse right
after insemination can affect the chance of pregnancy
positively. Try to get on with life as usual.
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The Pregnancy Test
You receive a home pregnancy test at the clinic.
Sixteen days after the insemination you take
the pregnancy test on morning urine.
If the test is positive, you will need another
ultrasound scan three weeks later.
If the test is negative, you must call your
gynaecologist and plan the next stimulation
when your menstruation starts. Please inform
the clinic of the test result.
How many inseminations?
Normally, the chances of pregnancy are almost equal
for the first 2-3 inseminations. After that, it drops dramatically. We therefore recommend that you try a different treatment option after three inseminations (eg
IVF). We never inseminate more than a maximum of 6
times in women under 40 years and 3 times in women
40-43 years, as the chances are too small and
then you are wasting your time.
For women 44 years and older we only offer IVF.
Insemination with donor sperm
Donor sperm
We use donor semen for single women without
a male partner or when the sperm is unsuitable
for insemination treatment. The reasons can be hereditary diseases or poor semen quality in cases where
IVF is not wanted.
The treatment is similar to the insemination with the
sperm of the partner. In cases where the woman
is under 35 years old and healthy, we often inseminate without previous stimulation in the first 1-2
treatments in order to avoid twins.
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Do you not have the possibility to go get ultrasounds,
you can also determine your ovulation using a urinary
LH test. Once the test is positive, please call the clinic
on phone +45 3834 9030 . Insemination occurs on the
day after the positive test. After you have called the
clinic, for safety’s sake you make an injection with an
ovulation inducing drug (Ovidrel, Pregnyl).
If you expect the positive LH test a Saturday, we
recommend that you on the Thursday have an ultrasound investigation because you perhaps can induce
the ovulation earlier.
We do not inseminate on Sunday.
Donor Choice
You can buy the semen directly at our clinic. In the clinic we have both open and anonymous donor sperm
in stock. According to Danish law, physicians are only
allowed to know the donor’s height, weight, eye colour, hair colour and blood type.
We buy our semen samples from two Danish
cryobanks: European Spermbank in Copenhagen
(www.europeanspermbank.com) or Cryos in Aarhus
(www.cryosinternational.com). Both Spermbanks
have additional information about the donors on their
websites.
The cryobanks are responsible for the semen quality
and state of health of the donors.
Should you have any special requests regarding
the donor, e.g. a particular ethnic origin, you can buy
the semen directly from the cryobank.
Once you are pregnant, you can make a reservation for
additional straws from the same donor for any future
siblings.
What you must be self-aware?
Drugs
We recommend that you reduce your intake of
medication to the smallest quantity possible during
pregnancy. Ask your GP in advance whether your
daily medication should be changed before you get
pregnant.
Medication and
possible side effects
Naturopathic preparations
We can not generally recommend them, because
that we know too little about the effect of these
preparations. If you need analgesic medications, we
recommend Paracetamol. We do not recommend
that NSAID use drugs during treatment and pregnancy. If in doubt, please consult your family doctor
or the pharmacy.
Gonal-F® (FSH), Puregon® (FSH) and Menopur®
(HMG) stimulate follicle growth in your ovaries.
Side-effects (rare): Local irritation of the skin,
tiredness, bloating, breast tension and abdominal
pressure when the ovaries enlarge.
Disease
Disease and fever above 38.5 degrees Celcius affect
the fertility of the woman and the man. We often
recommend discontinuing treatment.
Ovidrel® & Pregnyl® (hCG) finish oocyte maturation and cause ovulation 38-42 hours after injection. Side-effects: local irritation of the skin.
Vitamins
We recommend a multivitamin tablet daily with 400
micrograms of folic acid, and in the winter months
(October to May) 40 micrograms of vitamin D3.
You can find more information at
www.danfert.dk/en/research/lifestyle/
Pergotime® (clomifen) stimulates follicle growth
in your ovaries. Side-effects (rare): breast tension, hot flashes, headache, sleeplessness,
abdominal pain, very rarely affection of the liver
and blurred vision.
Cetrotide® & Orgalutran®: inhibit secretion of
endogenous LH and FSH from the pituitary. Sideeffects: local irritation of the skin, rarely nausea,
headache and exanthema.
Progestan® & Crinone®: Progesterone-analogue, stabilizing the receptivity of the endometrium. Side-effects: breast tension, nausea,
retention of body liquid, very rarely psychological
side-effects.
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Treatment results
Results
Your chance of becoming pregnant after insemination depends, above all, on the woman’s age and the
number of mature follicles.
Women under 40 years
Insemination with the sperm of the partner:
5 - 20% per insemination, depending on the number of
follicles.
Insemination with donor sperm:
15 - 30 % per insemination, depending on the number
of follicles.
Risks associated with insemination treatment
You can get pregnant with
twins (quite rare triplets),
one can get an ectopic
pregnancy, and to pass on an
inherited disease.
The risk of miscarriage increases with the age of the woman.
Women 40-43 years
Insemination with the sperm of the partner:
5 - 10 % per insemination, depending on the number
of follicles.
Insemination with donor sperm:
5 - 10 % per insemination, depending on the number
of follicles.
The chance of becoming pregnant is highest for
women below 30 years. It declines with the increasing
age of the woman. Women above 43 years become extremely rare pregnant with insemination and give birth
to a viable child. Therefore, we do not treat women
above 43 years with insemination but recommend IVF
or egg donation.
For more information , please visit our website
www.danfert.dk/en/about-us/success-rates/
DANSK FERTILITETSKLINIK . SEEDORFFS VAENGE 2 . DK 2000 FREDERIKSBERG
TEL +45 3834 9030 . FAX +45 3834 9600 . [email protected] . WWW.DANFERT.DK
. BANK: NORDEA REG. NR.: 2253 .
KONTONR.: 8477807314
BANK NORDEA DANMARK . SWIFT/BIC: NDEADKKK . IBAN NO: DK9520008477807314
CVR. NR.: 28954 824
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