Questions during IVF treatment

What is ICSI?

ICSI means IntraCytoplasmic Sperm Injection. By gently introducing a single sperm cell into each oocyte, the chance of fertilisation is increased when only few sperm cells or sperms with decreased motility are present.

What is IVF?

IVF means In Vitro Fertilisation (fertilisation in a glass tube). IVF is used when

  • The fallopian tubes are damaged
  • The woman has severe endometriosis
  • The man has low semen quality
  • You cannot find a cause, but you have not succeeded with insemination treatment (unexplained infertility)

At IVF the eggs are aspirated from the ovaries and fertilised in the laboratory. Two days later the fertilised egg is transferred into the womb.

What is TESE?

TESE means that you take sperm cells directly from the testicles (Testicular Sperm Extraction). This is necessary when the man has had a vasectomy or has missing vas deferens.

What is endometriosis?

In some women, endometrial mucosa is found outside the uterus in the abdominal cavity. It is observed in the ovaries, on the Fallopian tubes, the bladder and on the intestines. The most frequent symptom is abdominal pain just before menstruation begins. Endometriosis can also cause blood cysts inside the ovaries.

Endometriosis is more frequently found in infertile compared to fertile women. However, it is not proven that endometriosis is the reason for infertility in affected women. For some reason women with endometriosis have reduced pregnancy chances with insemination, and IVF is often recommended instead.

What is PCOS?

PCOS means “Poly Cystic Ovarian Syndrome”. To meet the criteria, two out of three symptoms must be present:

  • The woman has long cycles (> 35 days)
  • There are > 10 small follicles in the ovary at ultrasound image
  • The woman has acne, increased hairiness or elevated androgen hormones in the blood

Women with PCOS have problems ovulating. They are often also obese. Weight loss and diet modifications can often help. Alternatively, she must have hormone stimulation for egg maturation.

Does the hormonal treatment increase my risk of cancer?

No. So far, no investigations have demonstrated an increased risk of cancer. On the contrary, women who have given birth to a child seem to have a reduced risk of ovarian cancer compared to women who have never been pregnant. It is the pregnancy itself that decreases the risk.

Do I use all my eggs during hormonal stimulation?

No. Every single day, a certain number of eggs start the maturation process towards ovulation. Normally, only a single egg or follicle continues growing, the others die. By adding a little amount of hormone, more eggs continue growing and mature until ovulation instead of dying due to shortage of follicle stimulating hormone.

Why do I need hormones for IVF?

For IVF, we aim at having 6-8 follicles for oocyte pick-up. We do not necessarily obtain oocytes from all follicles, and not all oocytes are fertilised correctly. By having 6-8 follicles we feel pretty sure that there will also be 1-2 good embryos for replacement.

Do I need to inject myself during treatment?

Yes, the hormone stimulation substance is given as subcutaneous injections into the abdominal skin. Our nurses will demonstrate for you how to do this. If you feel difficulties in doing it yourself, your partner or a good friend can do it for you.

What happens, if I become pregnant during down-regulation?

It is not dangerous for the foetus. What happens is the following: you will not have your menstruation during down-regulation. Once you have a positive pregnancy test, down-regulation is discontinued and the pregnancy progresses normally.

When do I have to take the ovulation induction?

The ovulation inducing substance (ovitrelle or pregnyl) has to be taken exactly 36 hours before the planned oocyte pick-up. If you take it too early, ovulation will already have occurred when you arrive at the clinic. If you take it too late, the oocytes will not be ready for aspiration. In case you have forgotten to take the ovulation induction, please call us directly and ask for instructions. Often, it can be done 24 hours later.

Help! I have forgotten to inject the ovulation induction.

Try to call your contact doctor at the clinic. During evening times you find the phone no. on the letter to your physician. Do not take the medication at random time since this can spoil the treatment (remember egg collection has to take place 36 hours later!)

Does the oocyte aspiration procedure hurt?

No, you will not feel pain; it feels more like a menstruation-like discomfort. Before we obtain the oocytes, we give you an effective local anesthetic in the vagina and you will also have an intravenous painkiller. After the procedure, you rest for 20 minutes and are able to leave the clinic afterwards.

How many embryos are transferred after IVF?

Transferring more than a single embryo increases your risk of having twins. The risk depends both on the woman’s age and the embryo quality. The Danish National Board of Health has the following recommendations:

If the woman is younger than 37 years and she has more than a single embryo of top-quality, it is advisable to replace a single embryo and freeze the others at the first and second replacement.

If there are no embryos for freezing, two are often recommended.

For women over 40 years we are allowed to replace up to three fresh embryos, depending on the embryo quality.

When is blastocyst culture recommended?

The embryo develops into a blastocyst on the fifth day after oocyte aspiration. By culturing to the blastocyst stage, some embryos will stop development before that stage, and this makes it easier to identify the embryo with the best chance of resulting in a viable pregnancy. However, it does not improve the quality of the single embryo. We especially recommend blastocyst culture to young women with good quality embryos who want single embryo replacement. If there are several good quality blastocysts, the others can be frozen stored.

Will assisted hatching improve my pregnancy chances?

Assisted hatching means that the embryologist applies a small hole in the zona pellucida to allow the embryo to escape from the eggshell. It is not recommendable to perform assisted hatching for all women. The following groups may have advantage from this procedure:

  • women who have not obtained pregnancy after transfer of good quality embryo 2-3 times earlier
  • women over 40 years
  • women who received very high FSH doses for stimulation
  • when the zona pellucida is thickened
  • when frozen embryos are transferred

Can we have sex after embryo transfer?

After oocyte retrieval, the woman normally feels some tenderness in the lower abdomen and does not want to have sex. After one week the embryo has implanted into the uterus and sex does not hurt.

How many women will have twins?

In women less than 35 years with two top-quality embryos replaced, about 50 % will have a positive pregnancy test and 25 % will have a twin pregnancy. With single embryo transfer, about 40% will become pregnant and the risk of monozygotic twins is very small. In elder women, the risk of twins is decreasing. In our clinic, about 15% of all pregnant women have a twin pregnancy.

For how long time can frozen embryos be stored?

According to Danish law, embryos can be stored for 5 years. With the exception that after their 46th birthday, women are no longer allowed to have their embryos replaced.

What can I do myself do improve treatment outcome?

Have a look under lifestyle here at our homepage. Smoking, alcohol and obesity for both men and women have documented influence on the treatment outcome.

Is it necessary to have the pregnancy test done wham I have started bleeding?

Yes. Even if you have started bleeding, you can still be pregnant and continue with a normal pregnancy. In case the pregnancy test is positive and the woman has her menstruation, she might have an ectopic pregnancy. Therefore we recommend she always makes the pregnancy test.

Is there a risk of having an ectopic pregnancy using IVF?

Yes. One to two percent of all pregnancies after IVF are ectopic, even though the embryos were placed correctly inside the uterus.

When do I have the pregnancy scan?

You must have a pregnancy scan 3 weeks after the positive pregnancy test. At this time point we expct to be able to see a foetus with a heartbeat.

When do I have to stop the luteal phase support?

Normally, you must stop 3 weeks after the positive pregnancy test, which means you stop after the pregnancy scan. Some clinics already stop when the pregnancy test is positive. However, the clinical investigations demonstrating that you can stop that early cannot exclude that up to 5% of women will have an abortion stopping early. Therefore we recommend that you continue until the pregnancy scan.

Women who have become pregnant with frozen-thawed embryos in a hormone controlled cycle need to continue until 3 weeks after the pregnancy scan.

Is IVF free of charge?

Unfortunately not, even not for Danish citizens covered by the Danish health insurance (Sygesikringen). Only treatments in public hospitals are free.

Who can have treatment with IVF for free?

For having this treatment for free in a hospital, the couple must not have common children or shared custody. Only women under 40 years are treated and the couple must have lived together for a certain period of time.