INSEMINATION IUI. Engelsk Info IUI ~ 1 ~

Transcription

1 Engelsk Info IUI ~ 1 ~ INSEMINATION IUI

2 Engelsk Info IUI ~ 2 ~ In cases of unexplained infertility, irregular periods, ovulatory dysfunction or poor sperm quality, insemination of sperm cells directly into the uterine cavity can increase the chance of getting pregnant. This technique is called Intra Uterine Insemination (IUI). Prior to the insemination, the sperm is prepared in the laboratory by separating the sperm cells from the sperm fluid. In cases of very poor sperm quality or total lack of sperm cells, you can choose IUI with sperm donated from another man. In this situation, we will inform you of the procedure and the examination and selection of the donors. In cases of very poor sperm quality you can alternatively choose to use your husband's sperm anyway and perform so-called microinsemination also called Intra Cytoplasmatic Sperm Injection (ICSI) which means that we by use of a special technique, induce one sperm cell into each egg aspirated from the woman's ovaries. This technique only requires very few sperm cells. If you are interested in knowing more about microinsemination, just ask for our information on In Vitro Fertilisation/Microinsemination. Before entering the treatment we recommend the woman to be tested for Chlamydia (microorganism) in the vagina. If tested positive you will both need treatment for a few days with antibiotics. If the woman is not sure whether she has had Rubella, a blood test can clarify if she has antibodies against Rubella. If not, she will need a vaccination. Treatment of infertility cannot start before 3 months after vaccination. Tests for Chlamydia and Rubella are performed by your GP. Before treatment can start, both of you must be tested negative for HIV, Hepatitis B and Hepatitis C. Please study the enclosed material for further information. You are welcome to make an appointment for an introductory non-commital discussion or send us a letter/ with information concerning previous examinations and treatments you have undergone. Together we will then plan the most suitable treatment for you. If you live outside Denmark, the initial part of the treatment can be conducted by your local gynecologist. IUI-TREATMENT It is necessary for the IUI-treatment to lead to pregnancy that at least one tube (salpinx) is open. The woman has possibly undergone a so called HSG-test, an X-ray examination, which examines the passage through the tubes, or a laparoscopic examination of the tubes. If the tubes have not been examined previously, we can perform a HSU test, where we, guided by ultrasound, can flush water trough the uterus into the tubes, and thereby evaluate whether the tubes are patent or not. It is not strictly necessary for the IUI treatment to have any of these examinations performed, but if the woman has a history of pelvic infection, it is advisable to have the tubes evaluated before starting treatment. If the tubes are obstructed on both sides, surgery or IVF treatment is necessary. We use hormone treatment to increase the chances for pregnancy. The hormone treatment stimulates the ovaries to produce 2-3 follicles compared to the maturation of 1 follicle in a natural cycle. This increases pregnancy chances per cycle, but also increases the risk of a multiple pregnancy. The efficiency of the treatment depends on our ability to control the ovulation in order to perform the insemination at the right time.

3 Engelsk Info IUI ~ 3 ~ PRACTICAL PROCEDURES STEP BY STEP (See treatment schedule further on) You contact the clinic when your period starts. The woman must take medication (hormone tablets called Clomifen) from the 3 rd 7th day of the period. This drug stimulates the egg maturation in the ovaries and often leads to maturation of 2 3 follicles, which is highly desirable, as it increases the chances of getting pregnant. We add an extra hormone, FSH, (another egg producing hormone (Puregon, Gonal-f, Menopur or Bemfola) which at the same time also stimulates the mucous membrane in the uterus) for the following 3 days. It is taken as an injection, which you can very easily administer yourself. When you call us we also make an appointment for an ultrasound scan on your 10 th or 11 th day to evaluate the number and size of maturing follicles. When the follicles are 18 mm or more, a special ovulation-starting injection (Pregnyl or Ovitrelle) is given the same evening at a specific time given by us. You can also easily administer this injection yourself. The insemination will be 2 days later. If you live outside Denmark, it is important that your gynaecologist performs an ultra sound examination to secure the follicle development to be optimal, before you travel to Denmark for the insemination. If more than 3 mature follicles have developed, the treatment must be cancelled or the number of follicles must be reduced by puncture. THE SEMEN SAMPLE On the day of insemination, we need a semen sample delivered to the laboratory before 11 a.m. The semen sample can be produced in a special room in the clinic, but can also be produced at home if the transport time to the clinic is less than 1 hour. The preparation of the semen in the laboratory takes approximately 1 hour. We recommend that there should not be sperm ejaculation 2 days prior to the insemination day. DONOR SPERM If donor sperm is used in connection with the Fertility treatment, the sperm may come from an anonymous or open donor. We offer both anonymous and open donor sperm from our stock, but only matching the basic profile (height, weight, eye- and hair colour) from Scandinavian donors. We buy the donor sperm from European Sperm Bank. If you should have specific wishes or want a donor with extended profile, you have to choose, buy and have transferred the required sperm from the sperm bank Cryos or European Sperm Bank to our clinic prior to the treatment. Before using donor sperm we will guide you concerning the selection of the donor. You will need to sign a special declaration. According to Danish Legislation regarding fertility treatment (Law nr. 602, 18 June 2012) and The Danish National Board of Health, we are obliged to inform you of the following prior to treatment: By the selection of donors it has been attempted to limit the risk of transmission of hereditary diseases, congenital deformities, etc. by using only donors who have declared that they have no knowledge of such hereditary risks in their family, and where inquiries and examination have been carried out by an experienced health staff member in order to ascertain this information. In spite of these precautionary measures all hereditary risk cannot be excluded.

4 Engelsk Info IUI ~ 4 ~ Should the child, against all expectations, have health problems at the time of birth or during its first years of life, which according to the information you will have received may be hereditary, it is important that you report back to the clinic or to the health staff member who has treated you, in order to assess whether this donor can still be used. The same procedure shall apply if you are informed that there has been an infection from donor semen or donor eggs. Even if the donor has been declared free of transmittable diseases such as HIV and hepatitis the risk will never be zero. THE INSEMINATION After preparation in the laboratory, the sperm cells are injected into the uterine cavity by use of a very thin plastic tube. The procedure is without discomfort and takes only a few seconds. You can leave the clinic immediately after the insemination. We will hand you a pregnancy test (urine) to be used 14 days later. Please If the pregnancy test is positive, we will perform an ultrasound scanning 3 weeks later.

5 Engelsk Info IUI ~ 5 ~ TREATMENT SCHEDULE Cycle day 1 Start of menstruation 2 3 Tabl. Clomifen (normally 1-2 tablets/day) 4 Tabl. Clomifen 5 Tabl. Clomifen 6 Tabl. Clomifen 7 Tabl. Clomifen 8 Injection Puregon / Gonal-f / Menopur / Bemfola (normally i.e./day) 9 Injection Puregon / Gonal-f / Menopur / Bemfola 10 Injection Puregon / Gonal-f / Menopur / Bemfola 10/11 Ultra sound scanning (If the follicles are the proper size, ovulating inj. Pregnyl/Ovitrelle at 9.p.m) 12/13 Semen sample between 8-9 a.m. Insemination 1-3 hours later 27/28 Pregnancy test

6 Engelsk Info IUI ~ 6 ~ CHANCE OF GETTING PREGNANT Following insemination with the partner s semen, the chance of getting pregnant is % (depending of the age of the woman). When donor semen is used the chance of pregnancy is % The explanation of seemingly better results in cases of using donor semen is, that this is performed in couples where you have a fair explanation of the couple s infertility (poor sperm quality), whereas insemination with the partner s semen is applied to couples with unexplained infertility. ADVICE CONCERNING MATERNITY AND PATERNITY FOR COUPLES THAT WANT ARTIFICIAL FERTILIZATION. Regarding maternity: The woman who gives birth to the child is considered the child s mother, also in the case that the mother has been donated the egg from another woman. Regarding paternity: In case of artificial fertilization where sperm cells from the husband or from the man with whom the woman lives together are applied, the legal consequences in relation to paternity are the same as with natural fertilization. Regarding use of donor sperm: If donor sperm is applied for fertilization of a married woman, the husband will basically be considered being the father. In case of artificial fertilization of an unmarried woman with donor sperm, the partner who eventually lives together with the woman, must prior to the treatment in writing, together with the approval of the treatment, declare that he/she will recognize parenthood to the child. Regarding legal effects of parenthood: The parents of the child are under the obligation to provide for the child until the age of 18 years. The child has the right to carry the name of the parents and have right of inheritance from the parents. Regarding anonymity: Donation of eggs as well as sperm shall take place in anonymity. The identity of the donor must not be given to the receiving couple or to the child and likewise the donor must not be given information regarding the identity of the receiving couple or the child.

7 Engelsk Info IUI ~ 7 ~ MEDICINE IN RELATION TO IUI-TREATMENT Clomifen Stimulate the pituritary gland to produce more of the hormone (FSH) that induces the growth of the egg follicles. Puregon / Gonal-f / Menopur or Bemfola The hormone of the pituitary gland stimulating egg follicles. Stimulates the ovaries to mature more than one egg per cycle. Is also securing a proper maturation of the mucose membrane in the uterus thus enhancing the chance of the egg to implant. Given as injection in the stomach or upper leg. Pregnyl or Ovitrelle Ovulating hormone that is given when the egg follicles are considered of proper size to plan the insemination. Given as injection in the stomach or the muscle of the hip.

8 Engelsk Info IUI ~ 8 ~ The pricelist on our website is at all time valid PRICELIST ALL EGGS FROM IVF AND ICSI TREATMENT ARE CULTIVATED IN THE EMBRYOSCOPE WITHOUT ADDITIONAL CHARGE Introductory interview 1 Free of charge IVF/ICSI TREATMENT IVF-treatment 2 ICSI-treatment 25,000 Dkk. Freezing of fertilized eggs 2 First year is free of charge Transfer of thawed embryos 9,000 Dkk. Treatment with thawed embryos from an other clinic (regardless of transfer) 5,000 Dkk. Cancelled treatment prior to egg retrieval 5,000 Dkk. Cancelled treatment after egg retrieval (no transfer) 9,500 Dkk. Freezing of sperm from partner Storage of sperm or embryos (per year, for maximum 5 years) 2 Testicular sperm extraction (TESE) 3,000 Dkk. Assisted hatching (AHA) (per treatment) Use of anonymous donor sperm (per treatment) 2,250 Dkk. Use of open donor sperm (basic profile, per treatment) 3,000 Dkk. Cultivation of eggs in special medium Blastocyst cultivation Free of charge. Acupuncture 750 Dkk. Priming of the endometrium 3,000 Dkk. Copy of journal 200 Dkk. Administration fee for foreign patients (per invoice) 150 Dkk. CONTRACT UP TO 3 TREATMENTS For women up to and incl. 39 years IVF contract ICSI contract ICSI + TESE contract For women from 40 years up to and incl. 44 years IVF contract ICSI contract ICSI+ TESE contract 4 49,000 Dkk. 56,500 Dkk. 47,000 Dkk. 54,000 Dkk. 61,500 Dkk. CONTRACT UP TO 4 TREATMENTS For women up to and incl. 39 years IVF contract ICSI contract ICSI + TESE contract 5 6 7

9 Engelsk Info IUI ~ 9 ~ The pricelist on our website is at all time valid PRICELIST EGG DONATION (EXCL. MEDICINE FOR THE DONOR) Egg donation incl. 1 transfer of thawed blastocyst 3 37,500 Dkk TREATMENT WITH INSEMINATION (IUI) IUI-H (use of partner s/husband s semen) IUI-D (use of anonymous donor sperm from our stock) IUI-D (use of open donor sperm from our stock) IUI-D (use of donor semen from sperm bank) 5 4,250 Dkk. 5,000 Dkk. Ultrasound scanning of early pregnancy is included in treatments of IVF, ICSI and IUI. All prices are exclusive medicine. DIAGNOSTICS HSU (ultrasound guided examination of the uterine cavity and patency of the tubes) Sperm analysis 4 Chromosome analysis Statutory blood test for HIV and Hepatitis B + C AMH (blood test) Hormone analysis (blood test, pr. analysis) Chlamydia test Pregnancy scan Ultra sound scan without any further treatment 2,500 Dkk. 750 Dkk. 2,500 Dkk. 500 Dkk. 900 Dkk. 200 Dkk. 900 Dkk. 1,000 Dkk. 1,000 Dkk. 1 If cancelled later than 2 days prior to the interview the fee is 1,000 DKK. 2 First year storage is free of charge, thereafter we will charge per commenced year. 3 If there are no blastocyst(-s) for freezing 50% of the price will be refunded. 4 Free of charge if in connection with further treatment at the clinic. 5 Donor semen that you ve chosen and bought yourself directly from a sperm bank.