IVF-folder english

This information and guidance are aimed at childless couples and women who have been offered IVF treatment and IVF treatment with sperm microinjection

Information and guidance for childless couples and women  

IVF treatment 

The Fertility Department, Section 4071
Rigshospitalet
Web: rigshospitalet.dk/fert
September 2021

General conditions............................................................................................................... 5

Information film and webinar................................................................................................... 5

Who can be treated with IVF?................................................................................................  6

Examinations prior to referral .................................................................................................. 6

When will treatment be commenced? ............................................................................... 6

Part 1–Treatment ................................................................................................................ 7

How to commence treatment in practice ......................................................................... 7

Rejection to start treatment.....................................................................................................7 

Registration to use frozen eggs. ........................................................................................... 7

Special rules on registration for patients who are to undergo PGT ..........................8

Closing of the department during holidays ....................................................................... 8

Premises ......................................................................................................................................... 8

The actual treatment ................................................................................................................. 8

Stimulation protocol: ‘short cycle’ ........................................................................................ 8

      The stimulation ...................................................................................................................... 8

Stimulation protocol: ‘long  cycle’ ......................................................................................... 9

      Day 21....................................................................................................................................... 9

      Day ‘35’ - day 1 of stimulation ...................................................................................... 10

      Day 8 of stimulation ......................................................................................................... 10

Prior to oocyte retrieval ...........................................................................................................10

      Injection of ovulation hormone prior to egg retrieval ........................................... 10

Oocyte retrieval ......................................................................................................................... 10

Semen sample .......................................................................................................................... 11

Embryo transfer ........................................................................................................................ 11

      Risk of twins..........................................................................................................................12

      Pain in the period following egg transfer .................................................................. 13

      Treatment with progesterone in the vagina after egg transfer ........................ 13

Pregnancy test ...........................................................................................................................13

If you are not pregnant ........................................................................................................... 13

How many treatments are offered? .................................................................................. 14

Sperm microinjection (ICSI) ................................................................................................. 14

      Who can be treated with direct injection of sperm into oocytes (ICSI)?..... 14 

      What are the disadvantages and risks of ICSI? ..................................................... 15

Part 2 – Problems, side effects and risks ................................................................. 15

Cancellation of treatment before egg retrieval ............................................................. 15

The oocytes are not fertilised .............................................................................................. 16

Side effects and risks in connection with IVF ............................................................... 16

      Side effects of medication ............................................................................................. 16

      Hyperstimulation of the ovaries ................................................................................... 16

      Pelvic infection .................................................................................................................... 16

      Bleeding and spotting after egg retrieval .................................................................. 17

      Abdominal pain in the weeks following egg transfer ........................................... 17

      Pregnancy outside the uterus ...................................................................................... 17

      Is there a risk of developing ovarian cancer at a later stage? .......................... 17

Children born after IVF ........................................................................................................... 17

What can you do to increase the chances of a successful treatment? Lifestyle factors .......................................................................................................................................... 18

Scientific projects .................................................................................................................... 18

Part 3 – Results of IVF – chance of pregnancy ...................................................... 19

Part 4 – the practical aspects ...................................................................................... 19

Abscence from work ............................................................................................................... 19

Intercourse .................................................................................................................................. 19

Where to go if you experience problems .........................................................................20

Treatment in the private sector .......................................................................................... 20

Postponement of treatment................................................................................................. 20

‘Completed’ status after treatment .................................................................................. 20

Homepage and useful phone numbers............................................................................20

Part 5 – Treatment using fertilised eggs .................................................................. 21

Freezing and later thawing of fertilised eggs in connection with IVF treatment

      Which embryos can be frozen for future use? ....................................................... 21

      To what extent do embryos survive freezing? ....................................................... 21

      How common is it to freeze fertilised eggs? .......................................................... 21

      Are children born healthy?.............................................................................................. 21

      What is the chance of pregnancy when using thawed eggs? .......................... 21

How are the thawed embryos used? ............................................................................... 22

      How are treatments with frozen embryos scheduled? ...................................... 22

      Ultrasound scanning ......................................................................................................... 22

      Embryo transfer .................................................................................................................. 22

      Embryo transfer in an artificial cycle .......................................................................... 23

      Thawed-egg transfer after you have already had a child from one of your       'fresh' eggs ................................................................................................................................. 23

      Declaration - freezing of fertilised embryos ............................................................ 23

Part 6 - appendices............................................................................................................24

       Examples of the short and the long protocol..........................................................24

       Contact..................................................................................................................................25

This information and guidance are aimed at childless couples and women who have been offered IVF treatment and IVF treatment with sperm microinjection at the Fertility Department at Rigshospitalet. 

General conditions 

IVF is short for In Vitro Fertilisation, which refers to fertilisation outside the body (In Vitro means ‘in a test tube’). IVF is also known as ‘artificial insemination’. When the sperm cell is injected directly into the egg, this is referred to as IVF with sperm microinjection, or ICSI - an abbreviation of Intracytoplasmic sperm injection.  
 
This information material is a supplement to the consultation and information film and wabinar to which you will be invited prior to commencing your treatment.  

The information material is also intended as a help if, during your treatment, you become uncertain about something and need a more detailed explanation. 

Information film and webinar

In connection with your consultation, you will receive a link to an information film and webinar. In the information film we will explain the course of treatment in detail. The webinars are held approximately 5-6 times a year in the afternoon between 4:00 pm and 5:30 pm and usually there are around 100 participants. You cannot sign up for treatment until after the date of the consulatation.

The consulation

The first consultation will often be by phone or video. However, some will have a physical consultation.

Who can be treated with IVF? 

The following criteria have been established for IVF treatment in the Danish public healthcare system: 
 

  • Attempts with IVF treatment are considered medically reasonable. 
  • Treatment will be completed by the time the woman reaches the age of 41. Therefore, you will only be referred to treatment if, due to waiting time, there will be enough time to carry out a couple of treatment cycles before you reach the age of 41.  
  • We can treat married couples, cohabiting couples, single women and lesbian couples. 
  • To be eligible for treatment, couples are not allowed to have shared children living at home. This rule does not apply to treatment with frozen eggs (‘surplus’ eggs from previous IVF treatment kept in a freezer). 

Examinations prior to referral 

Prior to referral to the department, general medical tests will be conducted to establish the reason for your childlessness.  
 
Furthermore, there is a statutory requirement for the following tests to be available: Both the man and the woman must have blood samples taken to test for HIV and hepatitis B and C: 
 

  • Test for HIV (anti-HIV 1+2),  
  • Test for hepatitis B (HBVsAg and anti-HVBc), and  
  • Test for hepatitis C (anti-HCV).  

 
The test results must not be more than two years old. The tests must be taken by the referring physician, and we will check the results in connection with your consultation. 

When will treatment be commenced? 

After your preliminary consultation at our outpatient department, you can usually commence treatment. 

Part 1–Treatment 

How to commence treatment in practice  

When you get your period, please call the Fertility Department’s answering machine on +45 3545 4071, then press 3. The answering machine is only used for patients starting up IVF and ICSI treatments, and the phone is open for calls 24 hours a day.  
 
Please call on the day your period has started properly, i.e. the first day with fresh red blood. We call this cycle day 1. 
 
Please give the following information on the answering machine (remember to speak clearly): 

  1. Your name. 
  2. Your civil registration number (CPR number) 
  3. The date of your first day of bleeding. 
  4. Provide a phone number on which we can reach you from Monday to Saturday between 12:00 noon and around 2:00 pm in order to make arrangements for your treatment. 

 
From Monday to Saturday, the secretary will go through the calls from patients who have reported that they are ready to receive treatment. The secretary will then call you back between 12:00 noon and around 2:00 pm and ask you to show up at the department on cycle day 3 (“short protocol”, see next page for description of “short” and “long” protocol).  
 
Some patients will undergo what is termed “long protocol” treatment, and do not have to show up at the department until day 21 of their cycle. This may be relevant for: 

  • Couples where one partner is infected with Hepatitis or HIV, 
  • Couples where we retrieve sperm cells directly from the man’s testicle (TESA) 
  • Women with significant endometriosis  

Rejection to start treatment

Usually, there will be free slots for everyone signing up for treatment. We do, however unfortunately sometimes need to reject patients, as we are only able to start a limited number of new IVF treatments every day. If there are no free slots, you will have to sign up again next month.  
There is a risk that you will be rejected two-three times, but we do everything we can to avoid giving you more than two consecutive rejections.  

Registration to use frozen eggs 

Patients who are going to use frozen embryos may call the secretaries on +45 3545 4071, then press 1, on weekdays between 8:30 am and 10:00 am, and on Saturdays between 10:00 am and 12:00 noon. 

Special rules on registration for patients who are to undergo PGT 

(egg sorting due to a family history of genetic disease or chromosomal aberrations) These treatments must be coordinated with the Department of Clinical Genetics, who help us perform the analyses.  This is one of the reasons why the procedure requires special coordination. 

Closing of the department during holidays 

The department is open every day, including weekends and short public holidays. However, during summer holidays and Christmas holidays, we do not offer treatment. You can ask about the specific days during which the department will be closed. This information will also be posted on our website www.rigshospitalet.dk/fert 

Premises 

The Fertility Department is in Section 4071, which is located in Entrance 4, 7th floor.  
 
You can register yourself by the check-in booth or approach the reception.   

The actual treatment 

Our stimulation protocol may take two different forms: ‘short cycle’ and ‘long cycle’. The treatment is described below, and there are examples of a short cycle and a long cycle, respectively, at the end of this document.  
 
The ‘short cycle’ is the department’s standard treatment.  
 
In connection with your consultation at the outpatient department, we will seek to personalize your treatment as much as we can. For example, we count the small follicles in your ovaries, and we measure your ovarian reserve by AMH hormone levels in order to determine the best dose and treatment regime for your first treatment. 

Stimulation protocol: ‘short cycle’ 

He ‘short cycle’ is also known as ‘antagonist cycle’, see the table at the end of this guidance. This form of treatment is usually planned with you in advance. The necessary prescriptions will be available on the national prescription server so that you can collect your medicine at your local pharmacy. You will be assigned a time for an ultrasound exam and informed by telephone. Your appointment will usually be between 12:30 pm and 2:30 pm on the third day of your cycle.  

The stimulation 

The actual hormone stimulation treatment involves daily injections with a hormone. Usually, you will be treated with one of these hormones: Gonal-F, Bemfola, Rekovelle, Pergoveris, or Menopur. 
 
The hormones basically work in the same way. We will discuss with you which hormone we think you should use, and at which dose.  
           
The nurses will instruct you on how to take the medicine, which has to be injected subcutaneously. Furthermore, written information material will be available, showing you how to take the medicine yourself. 
 
Gonal-F, Bemfola, Rekovelle, Pergoveris and Menopur are expensive hormones. In a ‘standard’ IVF treatment, the costs of medicine alone amounts to approx. DKK 7,500 (EUR 1,000). However, the price you have to pay is considerably lower and depends on your medicine reimbursement status.        
 
Your prescription may cover a larger amount of hormones than you actually need. We do not know beforehand how much hormone you are going to need. We will guide you on how much you should buy. 
 
From cycle day 8, you will start taking Fyremadel in a dose of 0,25 mg daily to prevent you from ovulating before we can retrieve the eggs. 
 
On day 8 after commencing stimulation treatment (day 10 of your cycle), you will receive another ultrasound scan at the department. We will assess the number and size of your ovarian follicles and decide further treatment. In most cases, a few more days of stimulation will be needed before scheduling the egg retrieval.  

Hormone therapy: ‘long treatment cycle’ 

The principle of ‘long cycle’ is that you will receive a ‘pre-treatment’ for two weeks before commencing the actual stimulation treatment. During pre-treatment, hormone production in the pituitary gland is inhibited, thus ‘resetting’ the ovaries. 

Day 21 

Pre-treatment starting on day 21 of your cycle may either be by means of a nasal spray used three times a day, or by daily injections. The nurses will instruct you on how to use the Synarela nasal spray. You will have to take three puffs a day for the next 14 days. After 14 days, the dose will be reduced to two puffs a day.  
 
If you prefer treatment by one daily injection, you will be instructed on how to take 0,1 ml Gonapeptyl, which you will inject into the subcutaneous tissue of your abdomen for the next 14 days. 

Note 

Women with an irregular menstrual cycle for whom the long cycle has been planned: All women with a cycle of more than 35 days between the first days of bleeding should commence down-regulation simultaneously with birth-control pills. Consequently, for women with more than 35 days between bleedings, there should be a scheduled plan for how to get started with the treatment. These women will get a prescription for birth-control pills to trigger their period, and then they can call the department to sign up for treatment. These women must continue to take birth-control pills in the month in which they are to start the down-regulation. Typically, these women will have 3-5 pills left in their package when starting down-regulation. 

Day ‘35’ - day 1 of stimulation 

After two weeks of down-regulation, you will have to visit the Fertility Department again. The actual stimulation treatment can now be commenced, if your period has started. Often, your period will start 7-12 days after commencing treatment with Synarela or Gonapeptyl. Thus, your period is often a bit late, but that is not a problem. 
 
If your period has not started, you will still have a scan. You will then continue with Synarela or Suprefact, and your further treatment will be postponed for a week or two. 

Day 8 of stimulation 

One week after commencing stimulation treatment, you will have another ultrasound scan at the department. We will assess the number and size of your ovarian follicles and decide the further treatment. In most cases, a few more days of stimulation will be needed before scheduling the egg retrieval.  

Prior to oocyte retrieval 

Injection of ovulation hormone prior to egg retrieval 

When your ovarian follicles have fully matured, a nurse will instruct you on how to inject the Ovitrelle ovulation hormone. You will have to administer the injection at 10:00 pm. You inject the hormone into the subcutaneous tissue of your abdomen. This injection means that the eggs will be released no earlier than 38-40 hours later. Therefore, the egg retrieval will take place around 36 hours after the injection.  

Oocyte retrieval 

Egg retrieval usually takes place 11, 12, 13 or 14 days after start of stimulation. On the scheduled day, you will have to go to the Fertility Department at 8.15 am. You should bring the semen sample, or collect it at the department, depending on what has been agreed.  
 
You will be received by a nurse who will tell you when to take two pain relief tablets (Panodil 0,5 g x 2 = 1 g). The pills must be taken approx. one hour prior to the egg retrieval. The nurse will insert a small plastic syringe (PVK) into your arm through which you will receive pain-relieving medicine immediately before the egg retrieval.  We also use local anaesthesia in the top of the vagina. 
 
The actual oocyte retrieval is performed using ultrasound guidance. A fine needle is passed through the vagina to the ovaries. The follicular fluid is aspirated from the ovarian follicles with the hope that the eggs will be recovered in the process. 
 
The medicine can make you feel a bit drowsy, but you will always be awake during the procedure, and usually we will talk about what is going on. Oocyte retrieval usually takes around 20 minutes, and you can have someone there with you.

We usually perform between four and six oocyte retrievals per day. Patients meet at the department at 8.15 am in order to start the sperm purification process in the morning and get prepared before the egg collection. The first egg retrieval is performed at 9:00 am, but if there are a lot of patients, it may take up to two hours before it is your turn. The nurse will tell you when you need to be ready. Therefore, be prepared to spend all morning at the department. 
 
After the egg retrieval, you will have to rest for at least 15 minutes. After that you can go home. Sometimes you will have to stay at the department and rest for one to two hours. Do not plan on working on the day of the procedure. As you will be given sedative medicine, you will not be allowed to drive a car. You may experience abdominal pain after the egg retrieval. You may take paracetamol pain relief tablets (e.g. Pamol, Panodil, Pinex). 

Semen sample 

You should collect the semen sample at home, unless you live more than a couple of hours from the department.  
You should bring the sample collected at home on the morning of the egg retrieval. Your husband should refrain from ejaculation the last couple of days prior to collecting the semen sample. You will receive the container for the semen sample and further written and oral information about the semen sample on the day on which your appointment for egg retrieval is scheduled. 

Embryo transfer 

When you leave the department after oocyte retrieval, we will instruct you to call us two days later at 9:45 am on this number: +45 3545 4071, dial 5, press 1. 
When you call the department, we will tell you whether the eggs have been fertilised and the initial early development. You will also be informed whether you should meet for embryo tranfer the same day, usually between 12:00 noon and 2.00 pm, or whether we choose to cultivate the eggs to blastocysts to improve selection. If we choose to cultivate to blastcysts you should call again 3 days later and then be informed about the time for embryo transfer.  

If you are living in Jylland or Bornholm it can be arranged that the laboratory call you between 8.00 and 8.15 am on the day of potential transfer. 
 
Embryo transfer is usually painless and only takes a few minutes. It is performed much like an ordinary gynaecological examination, in which a narrow plastic tube is inserted into the cervical channel and the egg/eggs is injected in a small amount of fluid into the uterus. This egg transfer procedure is easier to perform if you have a full bladder. Therefore, you will be asked to drink two large glasses of water one hour before the scheduled time for embryo transfer.  
 
According to the 2007 guidance from the Danish Health Authority, under normal circumstances only one embryo should be transferred, provided that the eggs retrieved are of good quality, that the woman is under the age of 37 and that she is being treated in the 1st or 2nd cycle.  
 
In exceptional cases it is permissible to transfer two eggs. For example, this could be relevant in cases of severe endometriosis or high age. After each embryo transfer, a plan will be made if pregnancy is not established and another treatment round is necessary. 
 
We strive to avoid twin pregnancies. since on average, twins are born three weeks earlier than singletons and have an average weight of only approx. 2,500 g. Approximately half of all twins need to be hospitalised at the neonatal department.  
 
A study conducted by us, comprising more than 3,000 Danish children born as twins after IVF, revealed the following: 

Consequence IVF twins IVFsingletons 

Premature birth 

43.9%7.3%

Birth weight <2,500 g

42.4%5.9%

Stillborn

13.1/10006.6/1000

Neonatal hospitalisation

56.4%25.4%

Days of admission

19.811.0

Speech therapist

6.4%3.2%
Special-needs assistant/speech therapist/
occupational therapist
9.9%6.1%
Mental disability8.8/10008.2/1000

Therefore, the recommandation is to transfer just one fertilised egg at a time.

Pain in the period following egg transfer 

For 1-2 weeks after the embryo transfer, it is very common to feel abdominal discomfort  in the form of a pressure sensation and a certain bloating sensation. This is partly due to the stimulation of the ovaries, and it may partly be caused by the actual egg retrieval. The discomfort usually disappears after approx. one week. If you have any uncertainties, you are always welcome to contact us at the Fertility Department by calling a nurse on +45 3545 4071, dial 4, press 1, preferably between 9:00-10:00 am or 1:30-2:00 pm. 

Treatment with progesterone in the vagina  

Starting on day two in the evening following egg retrieval you will start treatment with progesterone, a natural hormone that maintains pregnancy. We are currently using the medicine Cyclogest. Your doctor will issue a prescription for Cyclogest as part of your medication. 

  1. Why do I need to take progesterone as vaginal tablets? Cyclogest contains the natural hormone progesterone. This hormone sustains the lining of the uterus and helps to avoid premature bleeding, thus improving your chances of getting pregnant. 
  2. What dose of Cyclogest should I take? 
    The dose is one tablet to be inserted directly into your vagina two times daily starting Day 2 after oocyte retrieval..

    You will have to continue with Cyclogest for 14 days. 
     
  3. Are there any side effects to the Cyclogest treatment? 
    The medicine contains the natural hormone progesterone that you already produce. Adding more of this hormone may cause fatigue, but the most severe discomfort that you may feel in the weeks after embryo transfer, is usually caused by the effects of the stimulation treatment and the oocyte retrieval - and not by the vaginal tablets. 

Pregnancy test 

A blood sample should always be collected, irrespective of whether you think you are pregnant or not. Of course, it is best if you are not bleeding, but it is an 'artificial system', and we have seen cases of pregnancy with a positive blood test, despite bleeding. Some women start bleeding before the time of expected period. There is nothing to do about such bleeding. 

On the day of the pregnancy test, you should go to the blood sample department on the ground floor between Entrance 4 and Entrance 5 to have a blood sample collected. Please call +45 3545 4071, dial 4, press 2 on weekdays between 12:45 pm and 1:15 pm to get your result. If your blood sample was taken after 10:00 am, you cannot get the result until the following day at 12:45 pm. 
If you live far away from Rigshospitalet, you can have the blood sample collected at your local hospital.  
 
If you are pregnant, an appointment will be scheduled for an ultrasound scan after approx. three weeks. The time of the appointment will be sent to your e-Boks.  
 
If you are not pregnant, a plan for your next treatment will already be given by a doctor in connection with the egg transfer. 
 
The probability of the pregnancy test being positive is around 30-35% after each egg transfer. Therefore, the majority of patients will have a negative result. This can be difficult for you. If you feel we can help you cope with this situation, please call us to make an appointment for a consultation with one of the nurses. 

If you are not pregnant 

You have to wait for your next normal period before you can call us about a new IVF treatment. There has to be an interval of at least one month during which you are not receiving treatment.  

How many treatments are offered? 

As a fixed rule, you will not be offered more than three embryo transfers with ‘fresh eggs’. Sometimes, however, a treatment cycle has to be interrupted before embryos are transferred.  We will not offer more than five treatment attempts with oocyte retrieval. In some cases, if special problems occur, patients will only be one or two treatments e.g. if fertilization failure occurs.

Sperm microinjection (ICSI) 

Intracytoplasmic sperm injection (micro insemination, ICSI insemination) 
Some patients undergo IVF treatment because the quality of the man’s semen is very low. In this case, we attempt to fertilise the oocytes by injecting a single sperm cell directly into each egg. 
Despite the method of fertilization, treatment is not different from any other form of IVF treatment.  

Who can be treated with direct injection of sperm into oocytes (ICSI)? 

This treatment is offered in two situations: 

  1. The man’s sperm quality is known to be so poor that other methods seem unfeasible. 
  2. You have previously been in IVF treatment, and it turned out that few or none of the eggs fertilised.  

What are the disadvantages and risks of ICSI? 

ICSI should only be attempted if ordinary IVF treatment is not possible or is not working well. 
 
A marginally higher incidence of chromosomal aberrations in fetuses after ICSI treatment cannot be ruled out.  
 
Severely reduced sperm quality is often due to hereditary factors. Even if the general chromosome examination of the man shows normal results, there may well be minor changes in the male chromosome (y chromosome). The reduced semen quality of the father can be transferred to some of the boys conceived by ICSI treatment, and there is a risk that these boys might need assistance in the future to become fathers themselves.  
 
The chance of getting pregnant using ICSI is the same as a regular IVF treatment. If you do not get pregnant after ICSI, the Fertility Department can usually offer insemination with sperm from a sperm donor. This treatment will then follow your own natural menstrual cycle. If you want to proceed with donor insemination, this will be planned further at a consultation that you can book with the secretaries. 
 
Prior to ICSI treatment, in most cases, the man will have been examined at the Department of Growth and Reproduction (Section 5064, Rigshospitalet). The examinations at the Department of Growth and Reproduction should be completed before you sign up for treatment at the Fertility Department.

Part 2 – Problems, side effects and risks 

The second part of this guidance provides information about the most significant problems, side effects and risks associated with IVF treatment. 

Cancellation of treatment before egg retrieval 

In about 5% of treatments, the treatment is interrupted before oocyte retrieval. The main reasons for this are: 
The hormone therapy is not having the desired effect. Typically, this is because not enough ovarian follicles are developing. In other cases, the ovarian follicles are not growing sufficiently, and blood samples show that not enough hormones are being produced. 
Treatment has to be cancelled in a few women to avoid hyperstimulation of the ovaries. 
The woman or the man could fall ill with fever (e.g. the flu) during the treatment. 

The oocytes are not fertilised 

Unfortunately, after 10% of all oocyte retrievals, fertilisation and cell division will not be successful and no embryos are available for transfer Usually, we do not know the reason for this. Sometimes it is because of poor sperm quality, sometimes it is because the eggs were immature or post-mature. 
 
For couples with so-called 'unexplained infertility', fertilisation and cell division will be unsuccessful after normal IVF treatment in up to 20% of cases. In these situations, IVF treatment will be replaced by ICSI (sperm microinjection) in the next treatment cycle.  

Side effects and risks in connection with IVF 

Side effects of medication 

Some side effects occur during down-regulation: headaches, hot flushes and mood swings. Hormone therapy with Gonal-F, Bemfola, Rekovelle, Pergoveris or Menopur stimulates the woman's natural hormone production and may give side effects such as bloating, breast swelling and tenderness, and abdominal discomfort. Some women report mood swings. 

Hyperstimulation of the ovaries 

The most important complication is hyperstimulation of the ovaries. Hyperstimulation always occurs after oocyte retrieval. The symptoms are especially pronounced in the first week after oocyte retrieval. However, if you become pregnant, the symptoms will become stronger and will typically peak during the first week after testing positive for pregnancy. We do what we can to prevent this complication by giving a different type of ovulationinduction  (Gonapeptyl 0.2 ml) and freeze all fertilised eggs.  Thereby we postpone embryo tranfer by one til two months. In rare cases the treatment will be stopped. With the precautions hyperstimulation occurs only rarely.

Hyperstimulation may be serious. Usually the treatment is admittance to hospital, bedrest and fluid treatment. Hyperstimulation leading to hospitalisation occurs in our clinic in 1 out of 300 treatments.

The symptoms are abdominal pain, bloating, nausea, vomiting and general malaise. If you experience these symptoms you can call the Fertility Department at the nurses phone +45 3545 4071, dial 4, press 1, best between 9:00-10:00 am og even between 1:30 and 2:00 pm.

Pelvic infection 

Even though oocyte retrieval is a sterile process, it can lead to pelvic inflammatory disease involving the ovaries. The infection may cause pain and fever. This type of complication occurs in connection with around 1 out of 500 egg retrievals, but more frequent in patients with endometriosis, who therefore receive profylactic antibiotics.. 

Bleeding and spotting after egg retrieval 

There will always be a little bleeding from the vagina immediately after oocyte retrieval. The light bleeding is caused by the insertion of the needle in the vaginal wall. Only very rarely does this lead to intense bleeding. In such cases, gauze will be placed in the vagina to stop the bleeding. However, around 1 out of 1,000 oocyte retrievals can lead to severe bleeding in the abdominal cavity, which may require surgery. 

Abdominal pain in the weeks following egg transfer 

As mentioned above, abdominal pain is frequent, however this is usually only mild pain. The pain is almost always due to the egg retrieval procedure itself and due to your ovaries being stimulated. The pain will disappear on its own but can sometimes persist for up to 14 days. If you feel sick, you should contact us. As mentioned above, you are always welcome to contact a nurse at the Fertility Department on +45 3545 4071, dial 4, press 1, preferably between 9:00 am - 10:00 am or 1.30 pm - 2:00 pm. 

Pregnancy outside the uterus 

As you know, the embryo is transferred into the uterus, but if your fallopian tubes are not normal, the embryo may slide out into the fallopian tubes. Just under 5% of pregnancies occur outside the uterus. This can cause symptoms in the form of bleeding and, possibly, pain, but these symptoms typically do not occur until around 14 days after testing positive in a pregnancy test. Surgery is the normal treatment for this type of complication. 

Is there a risk of developing ovarian cancer at a later stage? 

Several, new large studies indicate no increased risk of ovarian cancer after IVF treatment.  

Children born after IVF 

Children born after IVF have a very small increased frequency of abnormalities compared with children born after natural conception. This estimate takes account of the fact that mothers who receive IVF treatment are on average older and that many of the couples who say yes to IVF or ICSI have a disorder that may affect the child. 
 
Pregnant women are offered a nuchal translucency screening test and a blood test in week 11-12 of their pregnancy, as well as a scanning for abnormalities in week 18-20 like all other pregnant women. 
 
Children born after IVF generally weigh slightly less than the average for Danish children.  For example, single-born IVF-children weigh 70 grams less than the average child. This is because they are often born to older first-time mothers, and because more women who choose IVF have previously had abdominal surgery or suffer from certain disorders.  
 
Boys born after ICSI may inherit their father's poor semen quality. 

The most important complication after IVF treatment is the higher incidence of twins. Twins are often born prematurely, which may cause several problems (see the section on embryo transfer). 

What can you do to increase the chances of a successful treatment?

Lifestyle factors If a treatment is unsuccessful, there is usually a biological reason for this. There is very little  you yourself can do to increase your chances. However, some women can benefit from weight loss. This applies in particular to women with irregular periods. We do not offer fertility treatment to women with a BMI of more than 35. 

Tobacco
 
We know that smokers generally have a reduced chance of becoming pregnant than non-smokers. We always encourage both the woman and the man to stop smoking before fertility treatment.

Cannabis and other drugs.

Cannabis reduces sperm number and motiltity. Any use of cannabis or other drugs should be ended before we can offer fertility treatment. 

Scientific projects 

The Fertility Department regularly conducts various scientific projects. As a rule, the purpose of these is to improve our treatments. Everyone who participates in our projects will be informed both verbally and in writing. All our projects have approval from the relevant health research Ethics Committee and from the Danish Data Protection Agency.

Part 3 – Results of IVF – chance of pregnancy 

The probability of pregnancy (positive pregnancy test) after each embryo transfer is about 30-35%. 
 
Of those who become pregnant (achieve a positive pregnancy test result), around 70% give birth to one or more children.  

This is because: 

  • Of those who become pregnant, around 15% will only be pregnant briefly (biochemical pregnancy). This is seen as bleeding around the time of taking the pregnancy test, and a later negative pregnancy test after a further week 
  • Of those who become pregnant, 2-5% will have a pregnancy outside the uterus 
  • Of those who become pregnant, 15% will miscarriage 

Overall, almost 25% of each startet treatment will result in the birth of a child. The chance of pregnancy dependes primarily of the female age. A 39 year old will have have the chance as a 29 year old.

What is important for you is the following:  

The probability that you will have one or several children after your total treatment programme at Rigshospitalet is around 65%. 

Part 4 – the practical aspects 

Absence from work 

You should stay home from work on the day that you go to have your oocytes retrieved. Normally, you should be able to attend work on the day that we transfer the embryo into your uterus. Women who are hyperstimulated and have had many oocytes retrieved, should be more cautious than others. 

Intercourse 

We do not know whether or not having intercourse during the period following the embryo transfer has any influence on the chances of establishing a pregnancy. If you have had many oocytes retrieved and/or experience abdominal pain, you should probably avoid intercourse during the first week after the embryo transfer. 

Where to call in case of problems 

You can call the nurses at The Fertility Department on ohone +45 3545 4071, dial 4, press 1 between 9:00-10:00 am or 1:30-2:00 pm. The Fertility Department does not have a 24-hour service, so if you experience problems outside normal daytime hours that you think cannot wait until the next morning, you should contact the out-of-hours service (1813) or your local hospital. 

Treatment in the private sector 

Women can receive treatment in the private sector both before and after treatment in the public sector. This has no bearing on the public treatment programme offered. 

Postponement of treatment 

If you want to postpone your treatment for a longer period of time, please contact the secretary, who will then note this in your medical record. However, please note that if we have not had any contact with you within one year, we will automatically change your status to finalized. 

‘Completed’ status after treatment 

If you become pregnant, you will usually be registered with ‘completed’ status in our system three weeks after your positive pregnancy test, i.e. the day on which you have your ultrasound scan. In special circumstances (e.g. if you become pregnant with twins), as a rule you will go through an extra scan around two weeks later. 
If none of the treatments lead to a pregnancy, we suggest that you call us to schedule an appointment, during which we will review your treatment course as well as counsel you with regard to whether it would be reasonable to make a further attempt at IVF or ICSI pregnancy in the private sector. If you are not interested in this final appointment, please call or write to us. We will then change your status to ‘completed’. 

Website 

Our website www.rigshospitalet.dk/fert contains more information about the department and the various fertility treatments that we offer, but only in Danish.

Useful telephone numbers 

Contact with Secretary, tel. 3545 4071:  
Dial 1      Sign in for insemination and freezing treatment (8.30-10.00  a.m.) 

Dial 2      If you have any questions (10.00-12.00 a.m.) 

Dial 3      Sign in for IVF treatment incl. sign in for egg diagnostic (Answering          machine) 

Contact with nurses, tel. 3545 4071:  

Dial 4, press 1 If you have any questions (9.00-10.00 og 13.30-14.00 p.m.)

Dial 4, press 2 Result of pregnancy test (0:45-1:15 p.m.)

Contact with Laboratory, tel. 3545 4071:  

Dial 5, press 1 If you want status of your eggs (9.45-10.30 a.m.) 

Dial 5, press 2 If you have any questions (1.30-2.30 p.m.) 

Part 5 – Treament using fertilised eggs 

Freezing and later thawing and transfer of embryos 

The main objective of freezing embryos is to be able to use all embryos to achieve a pregnancy. Previously, when it was common practice to transfer 3-4 fresh embryos, freezing was not used very often. Today, we usually only transfer a single fertilised fresh embryo and we can therefore freeze and store the surplus embryos for future use if a pregnancy is not achieved at the first attempt, or if, after giving birth, you want a second child.  

Which embryos can be frozen for future use? 

Only embryos of the best 'quality' can survive freezing and thawing. Therefore, in some situations, there will be embryos which are fertilised and have begun cell division, but which will not be selected for freezing. For certain women with cancer who do not have a partner, there is the option of having oocytes (unfertilized) frozen using a special technique. 

To what extent do embryos survive freezing? 

More than 95% of embryos that are frozen can be used after thawing. 

How common is it to freeze fertilised eggs? 

In approximately 50% of treatments that involve embryo transfer there is a surplus of goodquality eggs which can be frozen.  

Are children born healthy? 

The is a very small increased incidense of congenital abnormalities in new-borns. 

What is the chance of pregnancy when using frozen-thawed embryos? 

The chance of achieving a pregnancy is almost 30% per embryo transfer when using thawed eggs. The chance of a live birth is around 22%. 
 
Fertility treatment using thawed embryos does not count as part of the maximum three attempts that you are offered in the public sector.  Before freezing and thawing, you and your partner will have to sign a declaration regarding the conditions pertaining to freezing and thawing the embryos.  Fertilised eggs may be frossen until the woman turns 46 years of age.

How are the thawed embryos used? 

The frozen embryos are thawed and then transferred into the uterus at mid menstrual cycle. Normally, the embryos will be transferred in a spontaneous cycle and at the most optimal time based on ultrasound scanning of the ovarian follicles and of the uterine lining (the endometrium). 

How are treatments with frozen embryos scheduled? 

You can have thawed embryos transferred following one month's treatment break. To schedule a treatment with frozen embryos, call us on +45 3545 4071, then press 1, on weekdays from 8:30 am and 10:00 am and on Saturdays from 10:00 am and 12:00 noon. If you get your period on a Sunday or a public holiday, you should call us the on the first weekday after. The secretary will schedule a scanning for you on day 12 of your menstrual cycle, unless otherwise agreed.  It happens rarely that we can not offer treatment with frosen eggs in a specific month.

Ultrasound scanning 

Normally, you will be scheduled for an ultrasound on day 12 of your menstrual cycle. The further process depends on the size of the ovarian follicle and on the thickness of the uterus lining. Some patients will have to come in for repeated ultrasounds before the egg transfer can be scheduled.  
 
When it is time to perform the embryo transfer, you will receive an injection with a hormone that stimulates ovulation (Ovitrelle).  
You will have to give yourself this injection in the evening at 10:00 pm. 

Embryo transfer 

The fertilised egges are either frosen at cell stage 4-6 (day 2) or at blastocyst stage (day 5/6).  The day of transfer depends on the stage and on whether you have a spontaneous cycle or a artificial cycle. 

You should call us at 9:45 in the morning. If the fertilised embryo has survived the thawing process, you will be told when to come to the hospital. Normally this will be from 12:00 noon-2:00 pm.

If you are living in Jylland or Bornholm it can be arranged that the laboratory call you between 8.00 and 8.15 am on the day of potential transfer.

Even though most of the fertilised eggs survive cryopreservation, the cycle has to be cancelled if the embryon does not survive the thawing proces.

Embryo transfer in an artificial cycle 

If your periods are irregular, you may benefit from hormone therapy. Hormone therapy consists of tablets with the natural sex hormone estradiol. Normally, you will have to take 2 mg estradiol tablets three times a day from day 2 to day 12 of your cycle. On day 12 of your cycle, you will be invited for an ultrasound and under normal circumstances, your embryo transfer can be scheduled to take place four days later.  
 
After this, in addition to three estradiol tablets, you will have to take a Cyclogest vaginal tablet two times daily for two weeks.  
 
If you become pregnant, and you are already taking both estradiol tablets and Cyclogest vaginal tablets, you should continue with this at least one month into your pregnancy. 

Thawed-egg transfer after you have already had a child from one of your 'fresh' eggs

If you have had a child from IVF at Rigshospitalet, and if you have 'surplus' eggs that have been frozen, you can be referred to us by stating that you have embryos stored and previously had a child. 

Declaration - freezing of fertilised embryos  

Freezing and possible subsequent thawing of fertilised eggs are subject to a number of requirements under Danish law. Before you can have your fertilised embryos frozen, you will have to sign a form indicating that you accept the following: 

  • Fertilised embryos may only be stored until the woman turns 46 years of age. 
  • Fertilised embryos may only be thawed and transferred if the woman, or both parties in a heterosexual relationship, agree on this in writing. This must be repeated each time one or more embryos are thawed 
  • In the event of legal separation, divorce, or if one of the parties dies, the embryos must be destroyed. However, the man may sign a declaration that his partner may use the embryos in the event of his death 


We will provide you with the forms for signature. You must confirm with your signature that you accept the above. 
 
Furthermore, you must provide your signature every time you want to make use of your thawed embryos.  
If the embryos are not used before the woman turns 46 years of age, they may be used for research. You will then receive a written request from us to use the fertilised embryos for a specific research project.  
 
If you accept this and both of you provide your written consent, the embryos will be used in the research project in question. If you do not consent, the embryos will be destroyed. 

Part 6-appendices and contact

Short treatment cycle
Long treatment cycle
Redaktør