- A fertility clinic with no waiting time.

Transcription

Welcome to Stork IVF Clinic A/S
- A fertility clinic with no waiting time.
We offer all forms of fertility treatments in a safe and caring environment.
Nina Stork, the founder of the clinic, who has been through countless insemination and
IVF attempts, has made some experiences in connection with her own fertility treatments.
She has thought a lot about how creating a child through fertility treatment can be made
more humane, dignified and respectful.
Having a child should be a nice and good experience, regardless of how it is
conceived.
Stork IVF Clinic works according to the same values as StorkKlinik, offering IVF treatment
in the same close and caring environment, which is characteristic of StorkKlinik. In order to
observe the current Danish legislation we can use anonymous and open donors ( also with
extended profile) after the 1st of October when using donor semen in treatment.
We strive to be a good alternative to other fertility clinics, and it is important to us that your
treatment becomes a personal experience that you can think back on with joy when you sit
with the child in your arms.
Stork IVF Clinic is open to all women and their men, lesbians and single women, as
StorkKlinik has been since 1999. We bring along our many years of experience with
women and couples undergoing fertility treatment as well as our extensive knowledge of
alternative family formation.
The staff at the clinic has years of experience in the treatment of infertility from both public
and private fertility clinics.
We offer plenty of time and attentiveness throughout the course of treatment, and we put
together the treatment with you that fits your needs and desires.
If you would like to network with others in a situation similar to yours, we will be pleased to
help you. You can meet other women / couples, both when you are undergoing fertility
treatment, through pregnancy and after birth. This can be done through contacts we can
pass on, or on informal information evenings at the clinic. - Or at our annual Stork-gettogether for children and their families.
Being pregnant should be a positive experience, regardless of how you become pregnant.
We look forward to welcoming you at Stork IVF Clinic.
Stork IVF•Klinik A/S St. Kongensgade 36-38, 1.th 1264 Copenhagen K Tel. +45 7060 6090 Fax +45 3257 3346
[email protected] www.StorkIVF.dk Nykredit reg.nr. 5472, konto nr. 0944572. SE nr. 33 03 49 11
[1]
Who will you meet in the clinic
We are a group of staff who have worked with IVF treatment for many years, both in public
and private fertility clinics. We look forward to welcoming you and your partner, if you have
one, and to offering you a good treatment. We have plenty of time, can offer you attention
and want to give you and your partner, if you have one, peace and quiet in connection with
your forthcoming treatment with us
Should you wish to see our faces, please go to our website www.storkivf.dk.
Contact & Opening hours
The clinic is open from 8.00 am – 16.00 pm every weekday and Saturday from 8.30 am –
1 pm - all year.
You are welcome to contact us via one of the possibilities below:
Telephone: +45 70606090
Email: [email protected]
Your call or email will be replied by either a secretary, doctor, a nurse, a midwife or a bio
analyst.
[2]
PART 1 – GENERAL
3
WHAT IS IVF .............................................................................................................................................. 3
WHEN TO OFFER IVF TREATMENT ............................................................................................................ 3
BOOK AN APPOINTMENT............................................................................................................................. 3
FERTILITY EXAMINATION .......................................................................................................................... 3
EXAMINATION OF THE MAN INCLUDES ...................................................................................................... 3
PART 2 – THE TREATMENT
3
HORMONE THERAPY "SHORT TREATMENT" ............................................................................................. 3
1ST STIMULATION DAY.
3
HORMONE THERAPY "LONG TREATMENT" ............................................................................................... 3
HOW MANY TIMES CAN YOU EXPECT TO MEET AT STORK IVF CLINIC ..................................................... 3
21ST DAY OF THE CYCLE
3
DOWN-REGULATION CHECK - FIRST STIMULATION DAY
3
8TH STIMULATION DAY
3
OVULATION INJECTION BEFORE EGG COLLECTION................................................................................... 3
SPERM SAMPLE ........................................................................................................................................... 3
EGG COLLECTION....................................................................................................................................... 3
PREPARATION AND PAIN RELIEF ................................................................................................................ 3
THE ACTUAL EGG COLLECTION ................................................................................................................. 3
REST AND PRECAUTIONS AFTER EGG COLLECTION ................................................................................... 3
FERTILISATION AND CULTIVATION OF THE EGGS IN THE LABORATORY ................................................... 3
IVF FERTILISATION
3
ICSI FERTILISATION
3
THE DAY AFTER EGG COLLECTION
3
2-3 DAYS AFTER EGG COLLECTION
3
PRECAUTIONS AFTER EMBRYO TRANSFER ................................................................................................. 3
PREGNANCY TEST....................................................................................................................................... 3
IF THE TEST IS POSITIVE ............................................................................................................................. 3
PREGNANCY SCAN ...................................................................................................................................... 3
IF YOU DID NOT BECOME PREGNANT.......................................................................................................... 3
PART 3 - SPECIAL PROCEDURES FOR IVF TREATMENT
3
TREATMENT WITH FROZEN / THAWED EGGS.............................................................................................. 3
TREATMENT WITH THAWED EGGS IN THE NATURAL CYCLE...................................................................... 3
TREATMENT WITH THAWED EGGS IN A HORMONE-STIMULATED CYCLE .................................................. 3
CULTIVATION IN EMBRYOSCOPE ............................................................................................................... 3
ASSISTED HATCHING .................................................................................................................................. 3
PART 4 – POTENTIAL COMPLICATIONS / RISK OF TREATMENT
3
CANCELLATION BEFORE EGG COLLECTION............................................................................................... 3
CANCELLATION OF EMBRYO TRANSFER .................................................................................................... 3
HYPERSTIMULATION OF THE OVARIES ...................................................................................................... 3
INFECTION OF THE PELVIC REGION ........................................................................................................... 3
PELVIC PAIN AFTER EGG COLLECTION / EMBRYO TRANSFER ................................................................... 3
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ECTOPIC PREGNANCY ................................................................................................................................ 4
CHILDREN BORN AFTER IVF ...................................................................................................................... 4
PART 5 - THE CHANCE OF PREGNANCY
4
PART 6 - TREATMENT WITH DONOR SPERM
4
ABOUT THE DONORS................................................................................................................................... 4
CHOICE OF DONOR AND CONSEQUENCES ................................................................................................... 4
RESERVATION ............................................................................................................................................ 4
PART 7 – LIFESTYLE AND FERTILITY
4
CHANGES IN YOUR LIFESTYLE ................................................................................................................... 4
FORESIGHT
4
DIET PRIOR TO PREGNANCY
4
VITAMINS AND FOLIC ACID
4
MEDICINES AND HERBAL REMEDIES
4
WEIGHT
4
EXERCISE
4
SMOKING
4
ALCOHOL
4
CAFFEINE
4
ACUPUNCTURE MANY WOMEN SUPPLEMENT THEIR IVF TREATMENT WITH ACUPUNCTURE. .................. 4
SICK PAY .................................................................................................................................................... 4
PART 8 - OPPORTUNITIES FOR NETWORKING
4
STORK-GET-TOGETHER.............................................................................................................................. 4
NOTICE BOARD IN THE CLINIC ................................................................................................................... 4
POSTING ON THE WEBSITE ......................................................................................................................... 4
ESTABLISHING CONTACT ........................................................................................................................... 4
PART 9 - MEDICATIONS FOR IVF TREATMENT
4
PHARMACY ................................................................................................................................................. 4
MEDICINE ACROSS BORDERS...................................................................................................................... 4
WHEN TRAVELLING FROM DANISH AIRPORTS ........................................................................................... 4
HOW TO TAKE THE MEDICINE .................................................................................................................... 4
HOW TO STORE YOUR MEDICINE................................................................................................................ 4
PART 10 - APPENDIX
4
SHORT VERSION OF "SHORT" TREATMENT ............................................................................................... 4
SHORT VERSION OF "LONG" TREATMENT ................................................................................................. 4
PART 11 – RELEVANT LINKS REGARDING:
4
ACT ON ARTIFICIAL INSEMINATION ........................................................................................................... 4
[4]
SPERM BANKS ............................................................................................................................................. 5
[5]
Part 1 – General
With this information material, you can find the most relevant topics in connection with IVF
treatment.
- How to register for this treatment
- When the treatment should be started
- What effects and adverse effects that are associated with IVF treatment
Our intention with this information is that we want you to be prepared to ask further
questions during the treatment so you can make the decisions that suit your wishes. We
encourage you to read the material carefully - and preferably several times. Then, the
information material can be used as reference Should questions arise along the way, we
will naturally reply to them.
What is IVF
IVF is an abbreviation of In Vitro Fertilization. This means that fertilisation
occurs outside the body (in vitro) in a test tube.
IVF is also called "test tube baby treatment" or "artificial insemination"
When to offer IVF treatment
- When a woman has blocked or damaged fallopian tubes, due to pelvic
inflammatory disease or appendicitis, previous caesarean section or surgery in the
abdomen.
- In case of severe endometriosis
- When the woman or the man is sterilized
- For unexplained infertility
- When you have not succeeded in getting pregnant by artificial insemination with
your partner or donor sperm
- When the man has poor sperm quality or no sperm in the ejaculate
- In case of unsuccessful hormonal stimulation or insemination in women with
endocrine disorders (anovulation, i.e. failure to ovulate or PCO)
Moreover, the woman must not be older than 46 years and you must have received oral
and written information about the consequences and risks of IVF treatment
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Book an appointment
Maybe you already know what next steps are, maybe you need an informal talk about your
situation with an opportunity to ask questions and get answers from a doctor and a nurse
specializing in infertility treatment.
The first consultation is used determine your infertility. We will also discuss any health
problems or problems with your fertility treatment.
The doctor will talk to you about the treatment we recommend and what treatment you
want. An ultrasound scan of the uterus and ovaries will be made. Subsequently, a plan for
your treatment will be made. You choose when the treatment should begin.
If you have previously received some form of infertility treatment, it would be an advantage
if we get a copy of the record note, stimulation schedules and lab schedules describing
egg development and your partner's sperm count.
The copies can be brought along, emailed or faxed to: +45 70606090
Infertility and treatment can fill the mind in different ways in the individual and can have
different consequences for both everyday life and future dreams. It often requires much
thought, deliberation and decisions in the process. Although at times it can be hard, try
also to focus on your life as a whole with many other facets. Remember, life has so much
more to offer than being childless and waiting to get pregnant.
Therefore you should of course live healthily, but also as normally as possible. Take the
holiday or break you need. And plan as far as possible to participate in festivities, seminars
and the like.
We'd love to help you to adjust the treatment so it suits you in relation to the life you live in
other respects.
Fertility Examination
The cause of infertility may lie with the woman. This may be due to tubal blockage, lack of
ovulation, endometriosis, fibroids or polyps in the uterus. The reason may also lie with the
man in the form of reduced sperm quality. A combination of reasons in both man and
woman is often seen. In addition, so-called unexplained infertility, where all investigations
are normal in both female and male. In order to have the best conditions and thus the best
chance of achieving pregnancy, it is important that an investigation is made.
[7]
Examination of the woman includes
- HIV, Hepatitis B (HBsAG + anti-HBc) and Hepatitis C
According to requirements from the Danish Medicines Agency
(Lægemiddelstyrelsen) these samples must be analyzed at a laboratory which
is certified according to the Human Tissue Act (Vævsloven) (in Copenhagen
this is the Statens Serum Institut and the blood bank at Copenhagen
University Hospital (Rigshospitalet).
-
Ultrasound scanning of uterus and ovaries
Analysis of the hormones Prolactin, FSH, LH, oestradiol and TSH(metabolism). If
you have irregular periods, we recommend an extended hormone status
Cell sample from the cervix, as we obviously want you to be 100% healthy before
you become pregnant.
Swab for chlamydia
Anti-Müllerin Hormone (AMH)
Rubella test as it can affect the child if you were to become infected with rubella
when you are pregnant.
Examination of the man includes
- Hiv, Hepatitis B (HBsAG + anti-HBc) and Hepatitis C
- According to requirements from the Danish Medicines Agency
(Lægemiddelstyrelsen) these samples must be analyzed at a laboratory which
is certified according to the Human Tissue Act in Copenhagen this is the
Statens Serum Institut and the blood bank at Copenhagen University Hospital
(Rigshospitalet).
-
-
We must always have an analysis of a semen sample before starting treatment at
Stork IVF Clinic. We prefer that the semen analysis is done by us. If you live far
away, we will sometimes accept that a semen analysis is done in a laboratory
closer to where you live. The test gives us an indication of what kind of fertilisation
procedure we should perform - either IVF or ICSI. The semen analysis must not be
older than 1 month. This is to reduce your risk of being left with a problem where
you have to take an unexpected decision at the egg collection.
(Please see the section on Fertilisation and cultivation of eggs)
If the sperm count is greatly reduced, additional examinations such as chromosome
analysis, ultrasound examination should be made. If you live in Denmark, we will
assess whether you should be referred to the clinic for Growth and Reproduction at
Rigshospitalet. If you are not resident in Denmark, we will help you to propose a
similar clinic in your country.
[8]
Part 2 – The Treatment
We use different kinds of therapies, but the most common treatments are the so-called
"Short" treatment, "Long" treatment and freezing treatment.
At the beginning you will receive a chart that describes the plan for your future treatment
with meeting times, medication and dose. Since the treatment must be adapted to you, we
may need to adjust a little on the progress and medication. We will talk about it along the
way, so you are not in doubt.
Registration for treatment
Once you get your period, please contact Stork IVF Clinic through one of the options
below:
Telephone: +45 70606090
On weekdays you can call between 8 am-15.30 pm, Saturday between 8.00 am – 1 pm. If
you are not able to get in touch with any of the staff, please leave a message on the
answering machine or send us an e-mail.
Please inform us of:
- Your name
- Your date of birth
- Date of the first day of your period
- What treatment we have agreed to be carried out (short, long, or freezing treatment)
- Telephone number and email address where we can contact you.
If your period begins Saturday after 1 pm, please leave a message on our answering
machine and call again Monday morning during telephone hours to get your scanning
time.
The day your period really starts, is what we call the first day of the cycle.
- If the "short" treatment is planned, you will be given a time to start and ultrasound
scanning on the second or third day of the cycle.
-
If the "long" treatment is planned, you will usually be given a time to start and
ultrasound scanning on the 21st day of the cycle, either here in the clinic or at your
own gynecologist.
In some cases it is not necessary to attend the clinic on the 21st day – this is
agreed individually at the time of registration.
[9]
-
If a freeze treatment has been planned with transfer of your thawed embryos in a
spontaneous cycle, you will get an appointment for ultrasound scanning on the 12th
day of the cycle.
If a freeze treatment has been planned with transfer of your thawed embryos in a
hormone stimulated cycle, you will get an appointment for an ultrasound scanning
on the 2-3 th day of the cycle.
If your period comes on a Saturday after 13 o’clock send an e-mail or leave a message on
our answering machine and call again Monday during phone hours ( 8- 15.30) in order to
schedule your scanning appointment. If you are part of a short treatment you will need an
ultrasound scanning Monday between the hours of 8.30 - 15.30 pm. More information in
Section 10, page 40.
Hormone therapy "Short treatment"
In the short treatment the eggs are collected on the 10th - 15th day of the cycle.
Please contact us when your menstruation begins. You will get an appointment for
ultrasound scanning on the 3rd day of the cycle and on this day you start with the follicle
stimulating hormone (FSH).
The day you start the FSH treatment is called the first stimulation day.
Stimulation can be done with several different drugs containing FSH.
FSH is the female hormone that your body already knows. It promotes the formation of
more than one egg, which you would otherwise produce each month. The hormone must
be taken as an injection, at same time every night (+ /  1 hour). Dosage is individual and
depends on your age, AMH, weight, number of follicles and perhaps previous treatments.
How many times can you expect to meet at Stork IVF Clinic
After your consultation, you should expect to meet on:
1.
2.
3.
4.
1st Stimulation day.
7th, 8th, 9th or the 10th stimulation day
Egg collection
Egg transfer
1st stimulation day.
You will be scanned, even if you have your period. We will make sure that the mucosa has
become narrow again and that you do not have a benign cyst in one of the ovaries. Such a
cyst may cause confusion in the hormonal balance and may mean that you will not
respond adequately to FSH stimulation.
If everything is in order, you should start the FSH hormone stimulation. Now we count from
the top and no longer refer to it as cycle days but in stead stimulation days.
6th stimulation day.
[10]
At an ultrasound scanning at this time the number of follicles and their size is estimated .
The number of follicles is individual.
If there are several follicles of 12 to 14 mm in diameter, you should start by taking either
Cetrotide or Orgalutran. It is taken by injection once daily in the evening.
It is very important to remember the injection as it holds back the ovulation. That way we
can determine and plan the day for the egg collection.
From day 8, take two kinds of medicine to the day where you should take the
ovulation injection.
The size of the follicles is essential for when the eggs must be removed. They can be
taken out when they have a diameter of 17 to 20 mm, as we know that the eggs will be
mature then.
Sometimes it is possible to determine as early as on the 8th stimulation day when you
should take the ovulation injection and when you should get an appointment for egg
collection.
At other times it may be necessary with a new appointment for ultrasound scanning and a
dosage adjustment.
Hormone therapy "Long treatment"
Please contact us when your menstruation begins. You will get an appointment for
ultrasound scanning on the 21st day of the cycle.
How many times can you expect to meet at Stork IVF Clinic
1.
2.
3.
4.
5.
6.
21st day of the cycle
Down-regulation control - first stimulation day
8th stimulation day
Perhaps 10th, 11th, or the 12th stimulation day
Egg collection
Egg transfer
If it is inconvenient for you on the specific day, you may have an appointment a few days
earlier if it is about a check on the 21st day or a down-regulation check.
21st day of the cycle
The down-regulation phase usually begins 21 days after your period.
Exception:
If you have irregular periods, i.e. a cycle of more than 35 days as a result of PCO or if you
tend to form cysts, you may begin a pre-treatment with contraceptive pills from the first day
of the cycle before down-regulation. When you have taken contraceptive pills for 18 days,
[11]
you will get an appointment for ultrasound scanning, and you will then start taking the
down-regulation hormone while you continue to take the rest of contraceptive pills in the
pack. The rest of the treatment is the same.
It is also possible to use a different hormone called Provera . This can be used if the
mucosa of the uterus is more than 5 mm thick and it will induce a menstrual period. We will
find the pre-treatment that suits you best.
Your uterus and ovaries will be ultrasound scanned to make sure that it is the optimal time
to start the down-regulation, either in the form of nasal spray, Synarela ®, or injections,
Suprefact ®.
On the 21st day of the cycle, the endometrium will be thick and there will be signs of
ovulation in one of the ovaries in the form of a collapsed follicle.
If you have been pre-treated with contraceptive pills, we cannot see any signs of ovulation
with ultrasound, but the mucosa will show signs of treatment with contraceptive pills.
When you take the down-regulation hormones, the pituitary gland (a gland in the brain)
inhibits the production of your own sex hormones FSH and LH, which therefore become
inoperative. The effect can be compared with a brief menopause-like state.
But not at first, at that time you will and should have your period from 7 to 12 days after the
start. The bleeding may be a little different from what you are used to. It may be a little
shorter period of time, longer or begin a little later.
You must have had your period for at least 3 days before you are ready to begin
stimulation therapy.
It is very important that you contact us if you have not got your period before
your next session in the clinic.
We will then give you a new time for an appointment, so you do not show up in vain.
The lack of menstruation may indicate that your own hormones are not yet steadily revised
downwards. If the absence of menstruation continues, we will assess whether you should
come and have an ultrasound scan. However, it is important that you keep taking your
down-regulation hormone.
The main purpose of down-regulation is to ensure that the ovulation does not occur
spontaneously before we take the eggs out, because then your eggs will be wasted. In
addition, the objective is to bring the ovaries in a state that makes hormone stimulation in
phase 2 being efficient and easier to control.
[12]
It is very important that you continue with the down-regulation hormone until
we have agreed when you should take the ovulation injection.
You can take down-regulation hormone in two ways. You can even choose what you want.
The effect is the same:
1. Nasal spray. You should take 1 dose Synarela, 3 times a day for 14 days. You
then proceed with 1 dose 2 times a day until it is time for the ovulation
2. injection. You should take 0.5 ml Suprefact by injection once daily for 14 days.
You then proceed with a smaller dose 0.2 ml until the ovulation injection.
You will receive a prescription for the drugs for the entire course of treatment. We will go
through the plan, teach you how to take the medicine and provide relevant guidance and
injection accessories.
Down-regulation check - first stimulation day
After 14 days of down-regulation, you will get an appointment to attend the clinic. You will
be ultrasound scanned again, this time to see if your ovaries have been steadily downregulated and to see if the mucosa is thin, as it should be when you have just had your
period. Some women still bleed at this time, which is not an obstacle to scan you.
If everything is ok, the stimulation begins. The counting is started over again, and we no
longer call it cycle days, instead it is called now called the 1st stimulation day.
Stimulation can be done with several different drugs containing FSH.
FSH is the female hormone that your body already knows. It promotes the formation of
more than one egg, which you would otherwise produce each month. The hormone must
be taken as an injection, at same time every night (+ /  1 hour). Dosage is individual and
depends on your age, weight, number of follicles and perhaps previous treatments.
You continue the down-regulation hormone in a smaller dose, i.e. now you must
take two different drugs until the day where you must take ovulation syringe.
You will get another appointment so an ultrasound scan can be performed on the 8th
stimulation day, i.e. when you have taken the hormone FSH for 7 days.
[13]
8th stimulation day
When this scan is performed, we will determine whether the FSH stimulation has led to the
formation of an adequate number of follicles. The number is individual.
The size of the follicles is essential for when the eggs must be removed. They can be
taken out when they have a diameter of 17 to 20 mm, as we know that the eggs will be
mature then.
Sometimes it is possible to determine as early as on the 8th stimulation day when you
should take the ovulation injection and when you should get an appointment for egg
collection.
At other times it may be necessary with a new appointment for ultrasound scanning and a
dosage adjustment.
Ovulation injection before egg collection
On the day where the ovulation injection must be taken, you should:
- Stop taking the FSH stimulation hormone
- The down-regulation hormone Synarela or Suprefact
is taken as usually in the morning and at 6 pm, and if you receive
Suprefact/Gonapeptyl in the long treatment you must take it at 6 pm.
- Orgalutran or Cetrotide, is taken at 6 pm if you are receiving the short
treatment.
The ovulation drug is called either Ovitrelle  or Pregnyl®. Both drugs contain the
hormone that helps to mature eggs. It is taken once, usually on one of the stimulation
days 9 – 12.
The injection is very important and must be taken on a completely fixed time in agreement
with us.
You may feel a tightness and fullness in the abdomen, after taking the ovulation injection.
If you accidentally forget to take the ovulation injection, it is not possible to
collect eggs at the egg collection and this cycle must be cancelled.
Sperm sample
On the day of the egg collection we need a sperm sample so we can fertilise the eggs. If
you are going to use donor sperm, we have semen in the clinic.
You can choose whether you want to make the test with us at Stork IVF Klinik, or if you
want to do the test at home. If you prefer the latter, the sample must be kept close to your
body and must not be more than an hour old when you deliver it.
In both cases you will receive test glass from us.
Upon receiving it we will ask you for your name, civil registration number and ask you to
sign a consent form.
[14]
You must deliver the semen sample at 8:30 am on the day of the egg collection.
The sperm sample is normally best if you have not had ejaculation within the last 24 hours.
Prolonged abstinence does not improve sperm quality.
The sperm cells must be separated from the seminal fluid and cleansed before being
added to the eggs. In this way, the best sperm cells are used in the fertilisation.
During the last 6 to 8 weeks before an IVF treatment you should avoid hot baths and
sauna, as heat can affect the sperm cells.
Fever can also have a negative effect on the sperm quality. You should therefore inform
us if have been ill with fever within the last 3 months before treatment.
(>38 C)
It may sometimes be difficult to make the sperm sample. If so, you do not bring one.
Usually, the sperm sample can be made after the egg collection, when you have calmed a
bit down.
If you know there might be problems with making the sperm sample, talk to us about it
beforehand. Then we can help you find a solution.
Egg collection
Many women may at the same time be both anxious and excited up to egg collection.
Will it go well? Will it hurt? How many eggs will be taken out? How will I feel afterwards?
We want to do our best to ensure that you have a good and pleasant experience during
your egg collection, though it is an unfamiliar situation.
When the eggs are going to be removed, you will have an appointment for 8.30 am
For some women it might be nice to bring someone you know well for the collection of the
eggs. We will talk with you to find out what we can do to support you best, so you can feel
comfortable and ready.
[15]
Preparation and pain relief
You are advised to eat during the day as it will reduce the risk of you being uncomfortable
due to too low blood sugar.
One hour before the egg collection procedure you will get 1 g paracetamol. If you wish,
you can also get a sedative.
We will insert a small plastic needle (venflon) into a vein. It will be used to give you
morphine (Rapifen ) during the egg collection.
When the practical matters have been performed, you will have the possibility to relax and
listen to music, if you like.
Just before the egg collection, you will be asked to empty your bladder as it makes it
easier to take the eggs out.
The actual egg collection
Both the doctor and the laboratory personnel will meet you. You must tell us your full name
and civil registration number. We need it to make sure that your name and date of birth is
correct.
During the egg collection, both a doctor and a nurse will be present. The laboratory
personnel will be in the room next door, and will be ready to receive the eggs.
In order to cover any pain we administer a combination of paracetamol, a local anaesthetic
with Citanest , which is placed on top of the vagina and Rapifen , a morphine drug.
We will place a small instrument on your finger that will measure your heart rate and your
ability to oxygenate your blood.
During the egg collection, we will inform you of what is going on and give your more painrelieving medicine, if you need it.
The egg collection is performed under ultrasound guidance through the vagina. A cannula
is inserted carefully through the vaginal wall into the follicles. Follicles lie close like a
bunch of grapes, therefore it is usually only necessary to insert the cannula 1 or 2 times in
each side.
The doctor empties the follicles by sucking the follicle fluid out. The fluid is given to the
laboratory personnel who at once examines it for eggs under a microscope. During the
egg collection we will tell you when they find oocytes.
You will be awake and can follow the procedure on the ultrasound screen, but you will
probably be a little drowsy / dizzy from the pain-relieving medicine you have received.
There is often a pleasant atmosphere where both you and we happily find out how many
eggs your body has managed to produce.
We will tell you about the number of eggs when the laboratory personnel have finished
their work.
The actual egg collection takes approx. 10 – 15 minutes depending on the number of
eggs and how easily they come out.
[16]
Rest and precautions after egg collection
After the egg collection, you should rest in the clinic at least half an hour in one of our
comfortable rooms. You can bring your own music, iPod or mp3. We hope you will find it a
positive and pleasant moment, even if pregnancy occurs somewhere other than home.
When you feel refreshed and the drowsiness from the pain-relieving drug is out of your
body you can go home.
The rest of the day you can expect to be tired and need to rest,
and you are not allowed to drive yourself the rest of the day.
You can expect a menstrual-like pain during the 24 hours after the procedure and you may
be somewhat sore for a few days. For the pain you may take Panodil®, Pinex® or
Pamol® (paracetamol), but you should avoid, wherever possible, Kodimagnyl® and
painkillers of the NSAID type (Treo®, Ipren®, Brufen®, etc.).
You may also experience a little bleeding afterwards. The bleeding is caused by the
injection sites in the top of the vagina and has no significance to your ability to become
pregnant. The bleeding must not exceed what you would experience in a normal
menstruation.
You are welcome to contact us if you are uncomfortable with the situation.
If you experience severe pain or fever, please contact us.
The embryos are usually transferred 2 – 3 days after having been collected.
If you live far away from Copenhagen, it is a good idea if you plan your stay so it will be
pleasant for you.
Fertilisation and cultivation of the eggs in the laboratory
Prior to the aspiration the laboratory regularly receives syringes with follicular fluid.
The syringes are emptied into so-called petri dishes, and the aspiration fluid is examined
under microscope. The eggs are surrounded by a cloud of cells called cumulus cells. This
cloud is very easy to spot.
The eggs will be placed in small dishes containing nutrient solution. They are then placed
into an incubator with an optimum environment, with the right pH value and temperature.
It is possible to fertilise the eggs in various ways either through IVF or ICSI.
[17]
IVF fertilisation
When the sperm sample has been cleansed, a certain amount of sperm cells will be added
to each of the small bowls, where the eggs are located. This is done 1-3 hours after the
egg collection.
The actual fertilisation is done by the egg and the sperm cell, in the same way it happens
in a woman's fallopian tube.
As soon as one sperm cell has found its way into the egg, a process occurs whereby the
"eggshell" is blocking for the penetration of more sperm cells.
ICSI fertilisation
When we perform the ICSI procedure on your eggs, we will remove a majority of all the
cumulus cells surrounding the egg 1-3 hours after aspiration. Under the microscope we
can now see the egg we will assess. We will assess whether the egg is mature enough to
be fertilised.
We will then perform an ICSI on the mature eggs. This means that we will select one
sperm cell under microscope and gently inject it into the egg.
The day after egg collection
About 20 hours after the fertilisation, we will assess whether the eggs have been fertilised
properly. A properly fertilised eggs has 2 pronuclei. One nucleus contains the genome of
sperm cell and the second nucleus contains the genome of the egg.
If no pronuclei are found at this stage, the egg has most likely not been fertilised.
2-3 days after egg collection
On the day where the embryos are transferred, we will assess the quality of the eggs. We
will asses it on the development of the eggs, i.e. how many cell divisions have the eggs
gone through in conjunction with appearance of the eggs.
On this day we also assess whether there are suitable eggs, which can be frozen.
The day of embryo transfer
The embryos are transferred 2 or 3 days after having been collected. The 2nd - and the
3rd day are equally suitable with regard to becoming pregnant and together we will decide
the right day for you. Whether you are going to have embryos transferred on the 2nd or
the 3rd day, you must always start with progesterone (Crinone® or Lutinus®) 2 days after
egg collection.
Embryo transfer is done the same way as a regular gynaecological examination.
If you have you tried to be inseminated, the procedure is almost the same. Instead of
sperm cells the small plastic tube will now contain fertilised eggs.
[18]
We usually transfer one or two embryos. The decision on whether it should be one or two
eggs depends on the quality of the eggs, your age, number of previous attempts and the
cause of your infertility.
Before we start the embryo transfer you will be identified by both the physician and the
laboratory personnel. We need to make sure once more that your name and date of birth
is correct.
We will then tell you how your eggs developed.
We will also discuss a possible next treatment. This is based on our experience according
to which many people want to know what options they have if they get a negative
response to the pregnancy test. This is certainly not because we do not believe in the
current treatment.
The fertilised egg is inserted through the cervical canal into the uterus with a thin plastic
tube.
Afterwards you will have the possibility to relax for half an hour in a comfortable room. You
can bring your own music, iPod or mp3. We hope you will find it a positive and pleasant
moment, even if pregnancy occurs somewhere other than home.
We want it to be a positive experience to become pregnant, regardless of how it occurs.
You will also be given an opportunity to receive acupuncture, should you desire it.
Precautions after embryo transfer
After the embryo transfer, you may suffer discomforts the next 1 to 2 weeks in the form of
dull sensation periodically "stabs" from the ovaries and a certain feeling of fullness. This
happens when the follicles fill themselves with fluid, and because the ovaries have been
stimulated. It can also be caused by the egg collection.
If you become pregnant, this period may be extended by another 2 to 4 weeks, but the
symptoms will gradually diminish.
We know that an unhealthy lifestyle will reduce your chance of becoming pregnant.
We recommend that you live as healthily as possible after the embryo transfer and avoid
hard physical exertion.
Hormone therapy after embryo transfer
Regardless of whether the embryo transfer is done on the second or third day, you must
start with progesterone supplements two days after the egg collection. It can be taken in
two ways and it is up to you to decide. The effect is the same.
Crinone
vaginal gel
90 mg 1 tablet once daily
Lutinus
vaginal tablet
100 mg 1 tablet x 3 times daily
Progesterone should be taken until the pregnancy test 14 days later. Should you begin to
bleed a few days before the pregnancy test, you must continue to take progesterone until
you have received the results of your pregnancy test.
[19]
Progesterone is a hormone the body produces from the corpus luteum in the ovary, when
you have ovulated. The corpus luteum (yellow body) is formed by the empty follicle, which
is where the egg was.
Our intention with the progesterone supplement is to strengthen the endometrium, so you
have a better chance of becoming pregnant.
Pregnancy test
About 14 days after embryo transfer, you must have a pregnancy test (HCG) in the form of
a blood test or a urine test.
It is important that the pregnancy test is performed, also if you have started to bleed. You
might bleed a little and still be pregnant.
The blood sample must be taken, whether you are bleeding or not
You can choose to have the blood test taken here at Stork IVF Clinic or let your own
doctor do it.
If the blood sample taken by your own doctor, please email or call the result to us:
Telephone: +45 70606090
In a few women it may be necessary to repeat the blood sample so we can follow the
development of the pregnancy. Too low elevations may reflect an incipient miscarriage or
give rise to the suspicion of an ectopic pregnancy.
If the test is positive
Contratulations!
If the pregnancy test is positive, you will get an appointment for a pregnancy scan three
weeks later, as you will then be in 7th or 8th week of pregnancy, as pregnancy is counted
from the first day of the last menstrual period.
[20]
Pregnancy scan
We perform a vaginal ultrasound scan about 3 weeks after the embryo transfer.
It can show:
- Whether you are pregnant with one fetus in the womb
- Whether there is heart action
- The size of the fetus
- Whether there is one or two fetuses
At this point we cannot scan for malformations or see the gender, we can only see if the
pregnancy is currently developing normally.
If it is easier for you, you can choose to have the pregnancy scan done where you live. We
are obviously very interested in, and will rejoice at the positive result. In addition, we must
report the results to Sundhedsstyrelsen (the Danish National Board of Health). It is
therefore really important that you mail us or call:
Telephone: 0045 70606090
If you did not become pregnant
Most people experience disappointment and frustration if the pregnancy test is negative
and your period comes. Whether you have tried to become pregnant in a short time or for
a long time, it may be associated with great sadness, a sense of powerlessness and even
a downturn. If you feel we can help you, please do not hesitate to call us and perhaps
make an appointment for a consultation with one of us.
It is very individual when you may want a new treatment. You should take the break you
need. It will usually be necessary with a month's "break" between treatments, so the
ovaries may "calm" down.
We know little about why we fail to become pregnant.
Some possible explanations:
- The woman's age is significant. The younger the woman is, the greater is
the chance of a pregnancy, as the quality of the eggs is better.
- Many fertilised eggs are not viable for very long, though they look normal
when they are transferred.
-
The mucous membrane is not susceptible to the eggs at that time
[21]
-
The cause of infertility affects the chance of becoming pregnant. Women
with fibroids in the uterus have a reduced chance.
-
Women with blocked and dilated fallopian tubes filled with fluid have a
reduced chance.
-
Life style factors, such as smoking, alcohol and overweight reduce the
chances of pregnancy.
Stress may also adversely affect the possibilities of getting pregnant
-
Part 3 - Special procedures for IVF treatment
Treatment with frozen / thawed eggs
The eggs can be frozen, if you have several fertilised eggs of good quality.
The method we use for freezing eggs - is vitrification and storage in liquid nitrogen at -196
° C. When freezing and subsequently thawing eggs they are exposed to extreme
conditions. Therefore, only eggs of a very good quality are vitrified.
Many children have been born as a result of this treatment, and there is no evidence of
increased risk of miscarriage, malformations or chromosomal defects.
1 or 2 of the best eggs will be transferred. The remaining eggs will be frozen, usually
earlier on the day of the transfer.
As we cannot predict whether there will be eggs for freezing and how many there will be,
we make the following plan with you:
- On the day when the eggs are collected, you sign a statement that you want
suitable eggs to be frozen.
- If the eggs are frozen, you will receive a statement on the day of the embryo
transfer in which we have made a note of the number of frozen eggs.
- If there are there no suitable eggs to freeze, the statement will be discarded.
The purpose of freezing the eggs is that you should not be exposed to hormone
stimulation and egg collection again if your first attempt fails.
Or better yet, the frozen eggs can be used when you have given birth and want
to get pregnant again.
In Denmark, the law requires that:
-
You must give a written consent to the freezing and storage, and declare that you
agree with the terms and conditions that apply.
[22]
-
The frozen eggs can be used only to treat you. We can never use the eggs for
other women.
-
The eggs can be frozen for a maximum of 5 years and cannot be used after the
woman's 46th birthday. If they have not been used before then, they must be
discarded. In case of separation, divorce, or one party's death, the eggs must also
be discarded.
When you have given your written consent, the eggs can be thawed and used.
-
We begin thawing the day before we have planned your embryo transfer, but most often it
is not until the day of the embryo transfer that we can assess whether the eggs are
suitable for use.
The laboratory staff will contact you by telephone so that you are informed of the
impending embryo transfer.
Treatment with thawed eggs in the natural cycle
This requires that you have regular menstrual periods and that you have agreed in writing
that we may thaw and use the eggs.
In this case there will be no further treatment med progesterone.
When you get your period you should call us to get an appointment for an ultrasound scan
around 10th -12th day in the cycle.
By means of ultrasound scan of the follicle and endometrium, we will find the best time for
the embryo transfer. When the follicle measures about 17 to 18 mm in diameter, you must
take the ovulation drug Ovitrelle Pregnyl®, and then the eggs will be put back 4 to 5
days later.
Sometimes it will be necessary to scan you few times before we can schedule your
embryo transfer.
Treatment with thawed eggs in a hormone-stimulated cycle
This requires that you have agreed in writing that we may thaw and use the eggs.
We recommend hormone stimulation therapy if you do not have regular menstrual periods.
When you get your period you should call us, or e-mail us, to get an appointment for an
ultrasound scan around the 12th day in the cycle.
The hormone therapy consists of Estradiol tablets. It is a sex hormone that your body
produces. You start at 2nd day in the cycle by taking 2 mg x 3 times daily. As the tablets
can cause nausea, it is a good idea if you take 1 tablet in the morning and 2 tablets just
[23]
before going to bed.
We will scan you on the 10th – 12th day in the cycle to assess mucosal thickness. When
the mucosa is ready, the progesterone therapy should be started. Either with Crinone 90
mg x 2 times daily or Lutinus 100 mg x 3 times daily.
You should continue with estradiol and start the progesterone therapy.
You must therefore now take 2 kinds of drugs.
The embryos are usually transferred 4 – 5 days later.
You must continue with estradiol and progesterone, until we know whether you are
pregnant.
If you are pregnant you must continue the treatment until the 10th week of pregnancy.
Fertilization by micro insemination
Micro insemination is also called ICSI = Intra Cytoplasmatic Sperm Injection.
Who will be offered ICSI
ICSI is offered:
-
When the man has few active sperm cells
If the sperm has been aspired from the testicles (TESA)
-
Where very few or no eggs have been fertilised by IVF
ICSI should therefore be attempted if the normal IVF treatment is not possible or does not
function well.
What are the disadvantages and risks in ICSI
The cause of severely impaired sperm quality is in some cases due to hereditary factors.
Although the ordinary chromosome examination appears to be normal, there may be small
changes on the male Y chromosome.
Therefore, it is possible that some boys born after ICSI, inherit the same problem in terms
of reduced sperm quality, as their father.
If you want to avoid this problem the only possibility today is donor insemination or
adoption.
We know that this situation for some will be a major disturbance and can feel like a rather
different challenge than what each of you had imagined. Some men may experience a
[24]
major or minor crisis when their semen does not function or cannot be used for a so-called
biological child.
When I, Nina Stork, write this it is because I sometimes think that we put obstacles in our
own way by attaching a specific meaning to the genes of our own family. Remember, that
we all possess genes from our forefathers and mothers. Look at the families that get 2 to 3
or more children, and see how different these children become.
A child is not only half its father and half its mother. It is the result of a giant mosaic of all
our far-far-away-aunts-to-uncle-uncle-cousin-mother-and grandmother, etc. This is just a
way of expressing the situation as diverse and varied as it is.
We cannot control what or whom the child will look like, either inside or outside. Not even
when our future child comes from our own eggs or sperm.
It's been very rewarding for years to have seen and been delighted about all the wonderful
children who have been born using anonymous donor sperm at StorkKlinik. At the time of
writing more than 2000. My talks with both children and their families, and my own process
to adopt the child my partner has given birth to has naturally influenced my view on genes
and biology. Being related has for me less and less to do with genetics. And more and
more with the emotional ties we associate with our children, regardless of where the genes
come from. And dear man, you will be, and will be regarded as 100% the father of your
future child, regardless of whether your own genes have contributed to it. You will be
responsible both legally, emotionally and as family.
Use of ICSI versus donor sperm for heterosexual couples.
There are many personal and ethical considerations behind a decision on the use of ICSI
vs. donor sperm. We will talk with you about these options if the woman is fertile and the
man has severely impaired semen quality.
The reason that we will talk to you about this at the first consultation is because we will ask
you in advance to consider your needs, opportunities and perhaps decide what you want.
There is a risk that on the day of the egg collection we will be faced with the problem that
there are no active sperm cells in the semen sample. What should we do then? Should
we discard the eggs? Should we fertilise the eggs with donor sperm? Should we freeze
the fertilised eggs if they are suitable for freezing, so you can consider using them?
We think it is better that you become aware of this issue and decide at your own pace,
rather than the sudden need to make a quick decision on the day of the egg collection.
Aspiration of sperm from the testicle
This procedure is called TESA = TEsticular Sperm Aspiration.
Although some men do not have live sperm in the semen sample, they may well have
live sperm in the testicles. It is possible to harvest the sperm. This also applies to men
who have opted to be sterilized.
[25]
The conditions to perform TESA is that the man has been examined and that there is a
chance to obtain sperm by aspiration.
TESA is always performed in the same treatment as when the woman takes hormones.
TESA is performed either the day before egg collection or on the day of the egg collection.
When the eggs have been collected, they are fertilised by means of ICSI.
The procedure only takes a few minutes once the local anaesthetic works (after 5 min.).
The doctor uses a thin needle to collect a small tissue sample, which is examined at once
by the laboratory. Sometimes a single sample is not enough and the doctor must therefore
try to extract sperm from the other testicle.
Then you rest for a half hour in the clinic.
There may be a need for a sedative. If so, you must not drive a car the same day.
There may be some soreness in the testicle, when the anaesthesia no longer works. For
the pain you may take Panodil®, Pinex® or Pamol® (paracetamol), but you should avoid,
wherever possible, Kodimagnyl® and painkillers of the NSAID type (Treo®, Ipren®,
Brufen®, etc.).
Should you experience severe pain, severe swelling of the testicle and / or fever you
should contact us or your doctor / emergency medical service.
There is a risk that we may not find any live sperm cells that can be used. Therefore we
ask you to consider the possibility of using donor sperm as an alternative.
Cultivation in Embryoscope
At Stork IVF Clinic the eggs are predominantly cultivated in a special incubator that takes
pictures of the eggs. This allows us to continuously assess the egg development and
quality on a computer without having to remove them from the incubator.
Assisted hatching
We can perform assisted hatching (AHA) on that / those eggs that should be returned.
This method may help the egg in the process it must go through to attach to the womb.
[26]
Part 4 – Potential complications / risk of treatment
Cancellation of treatment before egg collection / embryo transfer
For couples who are inexplicably infertile there is a major risk that the egg is not fertilised
or divides after ordinary IVF treatment. If you are in a relationship the fact that fertilisation
does not take place, is a possible explanation of why any previous insemination has failed.
Therefore, ICSI could be tried at the next treatment, which could increase the chance of
pregnancy.
We will discuss the causes in detail and the changes that will be relevant in order to
improve the next treatment and the outcome.
Cancellation before egg collection
May be due to:
The hormone therapy is not working well enough.

The hormonal stimulation has been too weak and for this reason there are too few
mature follicles. In some women, we usually do not expect many follicles, so we
rarely cancel for this reason.
Hormonal stimulation has been too strong and hence there is an increased risk of
hyperstimulation.

If the man or woman gets fever during treatment. The current production of sperm
can be affected. It takes about 3 months to produce a sperm cell and therefore it will
take 3 months before the sperm quality is normal again. Although the sperm cells
look normal, they often lose the ability to fertilise the egg.

If the woman is sick with fever, it may mean a greater risk of infection after egg
collection, and the eggs may also be affected.

Cancellation of embryo transfer
In some cases, there is unfortunately no fertilisation or division of the eggs. In other cases
the eggs have divided, but are of such poor quality that they cannot result in pregnancy
The reason for the lack of fertilisation / division may be due to the eggs lacking the ability
to become fertilised, poor sperm quality, immature or overmature eggs.
Another reason for the cancellation of embryo transfer may be a risk of overstimulation.
Please see the paragraph below on this.
We will regardless of the reason for cancellation talk to you about how we can optimize a
possible new treatment.
[27]
Medication effect / adverse effect
 Down-regulation: Synarela (Nasal Spray), Suprefact  (Injection) Gonapeptyl
0,1 mg ( injection) In 13 – 14
days the drugs inhibit the pituitary gland's production of FSH and LH In this way
(the hormone.
May cause transient flushing, headache, fatigue, dry mucous membranes and
mood swings.
Cetrotide, Orgalutran Inhibit the release of the woman's own FSH and LH from
the pituitary gland.

Stimulation treatment:
Gonal-F, Puregon, Elonva, Menopur, Pergoveris, Fostimon
Stimulates the ovaries to mature more than one egg. May cause short term pain
and tenderness at the injection site and breast tenderness. You may feel tired and
as the follicles grow, you may feel a fullness and tightness in the abdomen.

Ovulation hormone:
Ovitrelle, Pregnyl
May cause local irritation at the injection site.It is a hormone that helps to finish
mature eggs. It is taken once, about 35 hours before egg collection.
May cause local irritation at the injection site. You can get a little sore in the
abdomen after taking the ovulation syringe.

Finishing therapy (Progesterone)
Crinone, Lutinus
“Mucosal supportive”. Stimulates and maintains the mucosa of the uterus so the
egg has a good foundation. Sometimes postpones menstruation, even if you're not
pregnant.
You may feel tired and you may feel breast tenderness, nausea and headache.

General adverse effects:
All medication can cause allergic reactions. However, it is extremely rare for these
drugs. Other symptoms may include redness, swelling, itching, fever and in
extremely rare cases difficulty in breathing.
[28]
Hyperstimulation of the ovaries
Abbreviated OHSS = Ovarian Hyperstimulation Syndrome.
There is a risk of OHSS when more than 20-25 follicles are formed in a cycle. Appears in a
lesser degree at fewer follicles.
We try to avoid this complication by stimulating individually and carefully. Yet some women
react strongly and unexpectedly to hormone stimulation.
Symptoms may include abdominal swelling, abdominal pain, nausea / vomiting, increased
tendency to feel short of breath or difficulty urinating. Occurs due to fluid accumulation in
and around the ovaries. The condition can be very unpleasant, but the real
hyperstimulation syndrome occurs only if the ovulation injection has been taken.
In some cases, OHSS only appears when you are pregnant.
If you suspect that you are being overstimulated contact Stork IVF Clinic.
What you can also do:
-
Be sure to drink plenty of fluids, preferably 2-3 litres a day
Take it easy and avoid physical exertion
-
Be aware of changes in urination (is the amount small compared to what you drink)
-
Watch your weight. A large weight gain can cause you to accumulate fluid
Bleeding after egg collection
There is almost always a little bleeding from the vagina. The bleeding may maximum
be equivalent to a normal menstrual bleeding. The blood comes from the injections
on top of the vagina. On rare occasions the bleeding is heavier. In these cases, we
can place a long piece of gauze or put a few small sutures that dissolve by
themselves.
It has no bearing on your ability to become pregnant.
Infection of the pelvic region
Although the egg collection is sterile pelvic inflammation around the ovaries may occur.
Inflammation causes pain and fever. This complication is very rare and is treated with
antibiotics.
You can always contact Stork IVF Clinic, but you can also contact your own doctor or the
emergency medical services.
Pelvic Pain after egg collection
You can expect a menstrual-like pain during the 24 hours after the egg collection and you
may be somewhat sore for a few days. For the pain you may take Panodil®, Pinex® or
Pamol® (paracetamol), but you should avoid Kodimagnyl® and as far as possible avoid
painkillers of the NSAID type (Treo®, Ipren®, Brufen®, etc.).
[29]
After the embryo transfer, you may suffer discomforts the next 1 to 2 weeks in the form of
dull sensation, periodical "stabs" from the ovaries and a certain feeling of fullness. This is
due to the fact that the follicles are restored with fluid, the ovaries have been stimulated,
overstimulated or it may be due to egg collection.
If you become pregnant, this period may be extended by another 2 to 4 weeks, but the
symptoms will gradually diminish.
Complications after TESA
There may be some soreness in the testicle, when the anaesthesia no longer works. For
the pain you may take Panodil®, Pinex® or Pamol® (paracetamol), but you should avoid
Kodimagnyl®, and wherever possible avoid painkillers of the NSAID type (Treo®, Ipren®,
Brufen®, etc.).
Should you experience severe pain, severe swelling of the testicle and / or fever you
should contact Stork IVF Clinic, your own doctor or the emergency medical service.
Ectopic pregnancy
The fertilised eggs are transferred into the uterus, but the eggs may still flow into the
fallopian tube. Nearly 5% of pregnancies occurring after IVF are outside the womb.
If there is suspicion of an ectopic pregnancy and you get pain and / or bleeding, contact
Stork IVF Clinic. You can also contact your own doctor or a doctor from the emergency
service.
Risk of subsequent development of ovarian cancer
Several studies show, including a large Danish study that there is no increased risk of
ovarian cancer among women who have been hormone-stimulated
How can infertility treatment affect your life
With IVF treatment the expectations are high. In the same way, there may also be major
disappointments involved.
Be prepared for psychological ups and downs, which can be difficult to cope with. Our
experience shows that the women / couples who are open about their fertility treatment in
relation to friends or family, think it's a relief that close relatives and friends know why you
are not always on the top during the time the treatment lasts.
Remember that it is also okay to prepare the people you choose to tell about the future
treatment that it has nothing to do with them if you in the future can be a bit shorttempered, or simply do not want to talk about it. If your friends and family accept that you
also have a need for privacy during the treatment, it may a great advantage that those
closest to you know what you are going through.
Having trouble getting pregnant may be due to societal issues like pollution, working
conditions and our own parents' life style, etc. Things we cannot control now, and
therefore have no rational reason to be ashamed of, or be quiet about. So talk and share
your experiences with those you trust. We will also be happy to put you in contact with
[30]
others in the same situation.
Stork IVF Clinic is always available if you want to talk to us.
Children born after IVF
There is no evidence that children born after IVF treatment have more frequent
malformations than other children.
On an average children born after IVF treatment weigh 75 grams less than the Danish
"average child". This can be determined by several factors. The most important factor is
probably that the pregnancy is caused by artificial means, but also because the mothers
are on average older than other pregnant women.
The main problem of IVF pregnancies is the increased incidence of twins (and very rarely
triplets).
Twin and triplet births often occur too early and is all in all, associated with more
complications and risks. It is therefore essential to reduce the number of eggs being
transferred, and at the same time try to ensure a good chance of becoming pregnant.
Part 5 - The chance of pregnancy
As Stork IVF Clinic is a newly established clinic, we have not at present own results to
display. We therefore choose to disclose the average nationwide results in Denmark from
2010.
Clinical pregnancies per transfer of fresh eggs:
Women < 40 years:
Women > 40 years:
32.9 %
16.0 %
Clinical pregnancies per transfer of frozen eggs:
25.1 %
Clinical pregnancies mean both extra and intrauterine pregnancies, with or without a
heartbeat.
Once we have enough of our own results to show statistically, these will be available on
www.storkivf.dk
[31]
Part 6 - Treatment with donor sperm
About the donors
In Sundhedsstyrelsens (the Danish National Board of Health) instructions of 30.9.97. you
can read in detail about the medical examinations, the donors must go through before a
few (8 -10%) will be approved and may be used as sperm donors.
Before the donor sperm is released for sale, it must have been in quarantine, where the
donors must submit a negative HIV test, respectively 3 and 6 months after the donation.
This is the requirements from Sundhedsstyrelsen (the Danish National Board of Health) for
sperm banks to reduce risk of HIV transmission.
Donors are anonymous Scandinavian-looking men with a mean age of about 25 years. In
special cases, we can help with obtaining donor sperm of different ethnic origin.
Most sperm donors are students at universities in Denmark and their motivations are
typically both ideological and financial. To be approved as a sperm donor, the donors
must go through several medical examinations and have a "healthy" prehistory.
Until the 1. St of October 2012 only anonymous donor sperm is used for the treatment and
Stork IVF Clinic has no personal knowledge of the donors.
According to Danish legislation it is not possible to choose open donor sperm in Stork IVF
Clinic before the 1.st of October 2012. After 1.10. we propose open( with or without
extended profile) and anonymous donor semen.
What should I / we choose
You can make wishes for the future donor's characteristics such as eye colour, hair colour
and height and weight, if it is important to you. But it is not certain that all requests can be
met in a donor, but you are welcome to prioritise your donor wishes.
In relation to any donor wishes you should remember that no matter how the sperm donor
and the mother looks, the child may have completely different colours. Genes can jump
between generations in an unpredictable manner. This is also true for the child's height.
There is no guarantee as to how tall or short a future child is going to be.
It may therefore be an idea to honestly ask yourself / yourselves HOW important donor
wishes are. Even if you discover that it actually IS important to you, you must still be able
to accept that your child may look very different.
With regard to the future child's appearance, everyone is in the same boat.
We have no idea what our children will look like.
[32]
Choice of donor and consequences
The final choice of donor can be left to Stork IVF Clinic. Alternatively, you can make a
reservation for anonymous donor sperm. See below.
Stork IVF Clinic cannot guarantee the outcome of the treatment or for the child's
characteristics or physical and mental status.
If you do not become pregnant after the first IVF treatment and has to undergo a new
treatment, we sometimes use sperm from the same donor, and sometimes from a new
donor.
Reservation
If you want to order a special donor sperm home, you can do so yourself or leave it to the
Stork IVF Clinic. This must be done after the consultation and before starting treatment.
You must pay for the number of portions of donor sperm, you want to be sent to Stork IVF
Clinic and a shipping fee. The donor sperm will then be reserved in your name and stored
in a special container.
An annual administration fee should be paid for a depot.
At Stork IVF Clinic you also have the option to reserve sperm from the same donor, you
became pregnant with. You may therefore use the same donor for siblings.
For some women / couples, it is not important as children who grow up together, always
will be brothers and sisters - regardless of genetics.
Have you a child by treatment with anonymous donor sperm at a second clinic, Stork IVF
Clinic may investigate whether it is possible to obtain sperm from the same donor. You
must then obtain the donor number from the previous clinic.
[33]
Part 7 – Lifestyle and Fertility
Life style factors, such as smoking, alcohol and overweight reduce the chances of
pregnancy.
It is important to live healthily – perhaps you need to change habits!
There are more and more studies showing a correlation between lifestyle and fertility.
Therefore, it is a good idea to eat healthily and avoid or reduce consumption of stimulants
(coffee, cigarettes and alcohol).
Obesity can also adversely affect the possibilities of pregnancy
Changes in your lifestyle
Do you want to change habits regarding diet, smoking, coffee and alcohol, you should do it
for pleasure and because it feels right.
Furthermore, it may very well be that you are doing everything right and still not become
pregnant by the first treatments. It can be frustrating, especially if the elapsed time has
been characterized by severe deprivation.
Eat healthier, reduce the consumption of stimulants and do it at your own pace.
Except for smoking - so we recommend for your own and the child's fault that you stop
now.
Foresight
Foresight is a method developed by British doctors in order to optimize the future child's
health.
The philosophy behind Foresight is based on the concept that the healthier you and your
husband are BEFORE you get pregnant, the healthier the pregnancy will be. It has been
shown to also increase the chance of pregnancy.
It makes sense to be as healthy as possible even before you try to get pregnant.
You can read more about Foresight in the book "Planning for a healthy baby " by Belinda
Barnes & Susan Gail Bradly.
Everyone reads the book with different backgrounds, different experience and different
hopes.
According to Foresight attention and meticulous care before conception is useful.
You can read more about Foresight on their website www.foresight-preconception.org.uk/
Diet prior to pregnancy
The Danish National Board of Health - and we recommend that you eat 600 grams of
vegetables every day, potatoes do no count. In addition, fruit every day is also
recommended.
It is important that you get so few "white carbohydrates" as possible, i.e. preferably brown
rice, whole meal pasta, potatoes and whole meal bread than white rice / pasta / bread.
Eat plenty of fish, and vegetable proteins such as beans, lentils, chickpeas, etc. Meat of
good quality in moderate quantities, and plenty of raw vegetables
And healthy fat. A healthy and varied diet includes fatty acids that are important to the
metabolism of our cells.
Omega-3 (n-3): Fish oil, rapeseed oil, flaxseed oil, pumpkin seed oil, walnut oil.
[34]
Omega-6 (n-6): Thistle oil, sunflower oil, almond oil, corn oil and grape seed oil.
NB – When heated these oils lose their health-promoting properties.
Vitamins and Folic Acid
To prevent certain rare types of malformations of the brain and spinal cord in fetuses, the
Danish National Board of Health recommends that all women planning pregnancy daily
consume 400 micrograms of the vitamin B folic acid from the pregnancy is planned until
the third month of the pregnancy. This is recommended because it is difficult to obtain
enough folic acid through diet.
Medicines and herbal remedies
If you take any medicine, you should be aware of whether it can affect your ability to
become pregnant and whether it can be harmful. Talk to your doctor or with us about it.
At Stork IVF clinic, we think it is good that you strengthen your body optimally before
pregnancy. But we do not know the structure or the effect of all forms of natural medicine,
diet supplementation ect.
You need to know if the natural products you might be taking during the IVF treatment
support or interfere with hormone therapy. Therefore it is important that you consult a
health practitioner if you take any natural preparations or other remedies during the days
you are also in hormone therapy.
If your natural practitioner is in doubt whether the natural product is safe while taking
medications, you should avoid the product.
Weight
It is of great importance to be of fairly normal weight. Both over- and underweight in the
female reduces the chances of becoming pregnant.
For obese women it can be harder to become pregnant than women of normal weight.
If your BMI is over 27, it would be a great advantage to lose weight before you begin your
fertility treatment.
If your BMI is over 35, we will talk to you about specific plans for a future weight loss to
achieve a BMI less of 35 before starting fertility treatment.
BMI (Body Mass Index) is calculated as follows:
Weight in kilograms:
(height in m) x (height in meters)
For example 59 kg: 1.68 x 1.68 = 20.9
Overweight women experience more pregnancy complications than others, e.g.
hypertension, preeclampsia, gestational diabetes and premature birth.
At birth there may be problems with uterine inertia and stuck shoulders.
Malformations in children of obese mothers also occur more frequently, and late fetal
death also occurs more frequently. According to estimates, every 10 cases of late fetal
death could be avoided if all women were of average weight.
[35]
Exercise
Exercise is good for many things. That means you have greater physical and mental well
being - both now and during your pregnancy. You will have more energy and more muscle
mass and you would not feel as much strain during your pregnancy.
If you want to continue with fitness and workout training, you should avoid the hard and
high intensity. Sports with a risk of falling, crashing or blows to the abdomen should be
avoided entirely.
Studies suggest that the risk of miscarriage in early pregnancy increases a little bit, if you
do certain types of sport, such as jogging, ball games, workout / fitness and racquet
sports.
Nothing suggests that there is the same risk of miscarriage in connection with swimming,
cycling, walking / hiking and horseback riding.
We believe you should have this in mind when you exercise from the time of the transfer of
eggs until pregnancy and birth.
Smoking
It is vital that you stop smoking before you start on your fertility treatment. Nicotine has
numerous negative consequences for the child. Nicotine causes include frequent
spontaneous abortion, significantly lower birth weight, increased risk of late foetal death
and increased risk of premature birth.
Nicotine patches and other devices actually contain nicotine and can therefore not be
recommended for pregnant women.
Alcohol
Alcohol affects your ability to become pregnant and even a modest intake may be
important. Once you become pregnant you are advised not to drink alcohol at all, as even
quantities may harm the development of the fetus.
For the man the intake of alcohol is of less importance. High intake may, however, reduce
sperm quality.
Caffeine
More than 3 cups of coffee a day may have a negative impact on your ability to become
pregnant. A vast consumption may also adversely affect the pregnancy itself. Be aware
that caffeine is also found in cola, black tea, chocolate, etc.
[36]
Acupuncture
Many women supplement their IVF treatment with acupuncture.
Several scientific articles on acupuncture and fertility treatments have been published.
According to some of them acupuncture increases the chance of pregnancy, according to
others there is no difference.
Many, however, enjoy the relaxing effect that acupuncture has in most people.
Whether you want to supplement your treatment with acupuncture, please feel free to get
this treatment with us. Please visit www.Storkivf.dk for further information.
Sick Pay
If, in connection with the fertility treatment, you need to be on sick leave (individual
assessment by the physician), it is possible for your employer to recover the costs of sick
pay through a so-called § 56 agreement. (May 2011).
In Denmark, employers pay sickness benefits or sick pay during the employee's first 21
days of absence of any type of sickness. If an employee has a significantly increased risk
of sickness absence as a result of a chronic or prolonged illness, the employee and
employer can, however, conclude an agreement which gives the employer the right to
recover the cost of sickness in the first 21 days, every time the disorder is the cause of
sickness absence.
The statement form is available on various job centres and town halls and applies to those
who reside in Denmark.
You could try and find out if there are similar rules in your country.
[37]
Part 8 - Opportunities for networking
If you would like to network with others in a situation similar to yours, we will be pleased to
help you. You can meet other women / couples, both when you are undergoing fertility
treatment, through pregnancy and after birth. This can be done through contacts we can
pass on, or on informal information evenings at the clinic. - Or at our annual Stork-gettogether for children and their families.
Stork-get-together
Once a year we have a get-together for parents and children who have been born by the
aid of donor sperm.
Stork-get-together is directed at the children who have begun to think about where they
have come from, their family and how they were created etc.
It can be a great experience for kids to be with a large group of other children, many of
whom have come into being in another way than is usual and many of whom do not have
a father.
Stork-get-together creates an opportunity for parents to share experiences, contacts and
form groups or friendships with each other.
Our intention with the stork-get-together is:
- to celebrate the children and give them the experience of being many who come
from a unique type of family created in a very special way.
- that both parents and kids will have another opportunity to form new or meet old
networks and good contacts who might have similar joys and challenges of
everyday life.
- and that we all contribute a little bit to the children's mental images, thoughts and
feelings about "Who am I?" and "Where do I come from?".
Notice board in the clinic
In the clinic we have a notice board where we can post your notice. The notice board is
visible for those who come into the clinic for the first consultation or to be treated.
Posting on the website
You can also get in touch with other women / families through postings on the website.
Send us an email with your inquiry. Tell us a little bit about yourself and the group or type
of contact you are interested in.
Your inquiry will then be announced under women / couples looking for networks.
Establishing contact
Another way to make contact or initiate a parental or family group is to ask us to send your
letters or emails on to women / families we select to match you and your wishes. You will
most likely get a reply from about half of those we send the letters to. It costs DKK 200,because we take great care - it takes time to sort and find records on the women / families
which we hope would be interested in meeting you.
Information evening
[38]
We regularly hold information evenings which are advertised on the front page of our
website. Here you will have the opportunity to network with other women and couples in
the same situation. They may be undergoing fertility treatment, be pregnant or perhaps
they have become parents after a successful treatment.
We help to form groups or provide other contacts across the country and abroad.
Part 9 - Medications for IVF treatment
Pharmacy
Stork IVF Clinic has an agreement with the pharmacy Kongelig Hof-Apotek on Store
Kongensgade 45. This means that the pharmacy will always have the necessary medicine
in stock. When you are ready to begin your treatment and need medicine, all you need is
to walk across the street and get it. It takes 1 minute to get there. You will pay for the
medical expenses yourself.
If you have an appointment with us and the pharmacy is closed, we can deliver the
medication to you (if you pay a deposit) and an invoice for the medicine will then be sent to
you.
Some women only need relatively small doses of medication, others need more. We can
not pre-determine what the total drug spending will be, but a standard drug therapy can
run up to around DKK 10,000.
Reimbursement of medicine associated with fertility treatment
In January 2012 reimbursement rules for medicine used for fertility treatment in Denmark
was changed, and will once again be calculated in accordance with the ordinary
reimbursement rules for medicine, which also applies to all other medicine entitled to
reimbursement.
If you are resident in the EU, it is also possible to get the medicine in your own country via
a Danish prescription and thus obtain the reimbursement that applies in your own country.
We advise you to investigate the reimburse schemes that apply in your own country.
Medicine across borders
When travelling from Danish airports
Medicine produced as liquid, gel or similar form is exempt from the rules on liquids in hand
luggage in aircraft.
This means that you are allowed to bring liquid medicine in an amount greater than 1
decilitre per container. In the same way, the rule that containers with medicine must fit into
a transparent bag with a volume of 1 litre does not apply to you.
If your medicine is for regular daily use, you should bring it in your hand luggage. Then it
will be available even if your luggage is delayed. Other medicine, especially in liquid form
may be a good idea to pack in your suitcase. You should ensure that the medicine can be
safely stored in the aircraft's cold cargo hold.
[39]
You should be prepared that the staff at security checkpoints may require proof of the
authenticity of the product. You must therefore be able to prove that it is actually medicine
you are carrying.
You can do this by bringing:
- The liquid medicine in the original, sealed package from the manufacturer
- The prescription – take it with you from the pharmacy, even if it cannot be used
again
- Receipt for the purchase of the medicine.
-
If you fly from airports in other EU countries, you may be faced with a requirement
for a medical certificate stating the type of medication you use.
The documentation requirements for medicine and authenticity may be different in each
country.
Just as the law of the country determines which and how much medicine you may bring in
and out of the country. This applies both to travel to EU countries and to other places in
the world.
We can make a statement for you if you need one for your return.
How to take the medicine
Some prefer to take the injections themselves, others want someone else to do it.
Whichever type of medicine you should use, you will receive careful instructions in the
clinic.
Medicine, sharps container, injection accessories, portable cooler is handed out in the
clinic.
At the same time you will also receive a chart that describes the plan for your treatment
with meeting times, medication and dose.
If you are in doubt about what we've talked about and shown you, you can always visit our
website www.storkivf.dk and see how you take your medicine.
[40]
How to store your medicine
Drug
Storage before
opening
Storage after
opening
Shelf life after
opening
Synarela nasal spray
Below 25C
Below 25C
See date on the bottle
Suprefact
Below 25C, protected
from light
from light
from light
2-8C (below 25C for
30 days)
Below 25C
14 days
Not applicable
Not applicable
Puregon
30 days)
Below 25C
28 days
Gonal-F
2-8C, protected from light Below 25C
28 days
Pergoveris
from light
from light
Must be used
immediately after mixing
Below 25C
Must be used immediately
after mixing
after mixing
from light
Below 25C
28 days
Menopur multidose
from light
2-8C
Bravelle
Below 25C
Ovitrelle
30 days)
Below 25°C, protected
from light
Not applicable
after opening
Not applicable
Pregnyl
2-8C
Not applicable
Not applicable
Lutinus
Room temperature
Until expiry date
Until expiry date
Crinone
Below 25C
Until expiry date
Until expiry date
Orgalutran
Cetrotide
Elonva
Fostimon
Menopur powder
Must be used immediately Must be used immediately
after mixing
after mixing
Below 25 °C
Max. 30 days
28 days
[41]
Part 10 - Appendix
Short version of "Short" treatment
Cycle day 1:
You call us to register by phone: + 45 70606090 or by sending an
email to: [email protected].
On weekdays you can call between 8 am-15.30 pm, Saturday
between 8.30 am – 1 pm
- Your name
- Your civil registration number
- What treatment we have agreed to be carried out (short, long,
or freezing treatment)
- Telephone number and email address where we can contact
you.
If your period begins Saturday after 1 pm, please leave a
message on our answering machine/send an e-mail and call
again Monday morning during telephone hours to get your
scanning time.
Cycle day 3:
Ultrasound scanning and plan for treatment. Start the FSH
hormone stimulation – 1st stimulation day. Instruction in medicine
administration.
8th stimulation day:
Ultrasound scanning and possible adjustment of the FSH dose.
You will start by taking Orgalutran or Cetrotide. You should
continue with FSH.
You are now taking two kinds of medicine, until the day where you
should take the ovulation medication. Maybe you will need
another ultrasound scanning before we can determine the egg
collection day.
Egg collection:
You will get an appointment at Stork IVF Clinic.
Remember to bring the sperm sample or it can be done in the
clinic. If you want to use a donor, we have the straws in the clinic.
You will talk to the nurse, get paracetamol, and, if necessary, a
sedative and a venflon is inserted. You will meet the doctor and
the laboratory staff and the number of eggs that should be
retrieved is agreed.
Egg transfer:
2-3 days later you return at the agreed time. Regardless of
whether the eggs are to be transferred on the 2nd or the 3rd day,
you should always begin the progesterone treatment (Lutinus /
Crinone) 2 days after egg collection.
[42]
[43]
Pregnancy tests: Is taken as a blood test either here at the clinic or by your own
doctor. Email the result to: [email protected] or call +45 70606090.
- Positive:
Pregnancy scan approx.
3 weeks later.
- Negative:
Can start treatment again when you feel ready. If a new
treatment plan has not been made, it could be done at this time.
[44]
Short version of "Long" treatment
Summary "long" treatment IVF / ICSI
Cycle day 1: You call us to register by phone: +45 70606090 or by sending an email to:
[email protected].
On weekdays you can call between 8 am-15.30 pm, Saturday
between 8.30 – 1pm.
- Your name
- Your date of birth
- What treatment we have agreed to be carried out (short, long,
or freezing treatment)
- Telephone number and email address where we can contact
you.
If your period begins Saturday after 15, please leave a message
on our answering machine/send an e-mail and call again Monday
morning during telephone hours to get your scanning time.
Cycle day 21:
Ultrasound scanning and plan for treatment. Start the downregulation Synarela or Suprefact/Buserelin. You may not
have to come to the clinic that day, if you know how to take
the medicine. If needed, instructions regarding administration of
the medicine
If your period has not started, please contact us.
1st stimulation day:
Down-regulation control. Ultrasound scanning. Start the FSH
hormone stimulation. Instructions in administration
of the medicine. You are now taking two kinds of medicine, until
the day where you should take the ovulation medicine.
8st stimulation day:
Ultrasound scanning and possible adjustment of the FSH dose.
You should continue the FSH and down-regulation until the day
where you should take the ovulation medicine. Maybe you will
need another ultrasound scanning before we can determine the
egg collection day.
Egg collection:
You will get an appointment at Stork IVF Clinic at 3:00 pm.
Remember to bring the sperm sample or it can be done in the
clinic. If you want to use a donor, we have the sperm straws in the
clinic.
You will talk to the nurse, get paracetamol, and, if necessary, a
sedative and a venflon is inserted. You will meet the doctor and
the laboratory staff and the number of eggs that should be
collected is agreed.
[45]
Egg transfer:
2-3 days later you return at the agreed time. Regardless of
whether the eggs are to be transferred on the 2nd or the 3rd day,
you should always begin the progesterone treatment (Lutinus /
Crinone) 2 days after egg collection.
Pregnancy tests: Is taken as a blood test either here at the clinic or by your own doctor.
Email the result to: [email protected] or call 0045 70606090.
-
Positive:
Negative:
Pregnancy scan approx. 3 weeks later.
Can start treatment again when you feel ready.
If a new treatment plan has not been made, it could be done at
this time.
[46]
Part 11 – Relevant links regarding:
Medicine across borders
Indenrigs og sundhedsministeriet
www.im.dk
Act on artificial insemination
Sundhedsstyrelsen
www.sst.dk
Sperm banks
Nordic cryobank
Cryos
www.nordiccryobank.com
www.cryosinternational.com
Please feel free to contact us if you have suggestions for other relevant links.
[47]

- A fertility clinic with no waiting time.

Transcription

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