Doctor's Corner

This page is specifically aimed at practitioners who need a quick overview.

New rules on referral

Now couples and women who have children / children must again be referred to fertility assessment and treatment in specialist medical practice with coverage from the Region.

Who can be referred:

• Heterosexual couples
• Single women
• Lesbian couples

As a specialist medical practice company Trianglen has an agreement with the Region (external number), so that infertile women/couples can be referred for examination and insemination treatment with coverage from the Region. This applies regardless of whether the woman / couple has a child in advance.

If donor semen is used, however, there is a personal fee for the semen.

IVF and ICSI treatments are always self-payable in private fertility clinics

The woman must be under 39 years of age to be referred to a public clinic.

In private clinics, women can be treated until they turn 46. In practice, however, it is extremely difficult for most women to become pregnant - even during fertility treatment - when they are over 42-43 years.

How long should the couple try before referral?

If a younger couple (under 35) have tried for one year or more without achieving pregnancy, there is usually one or more fertility-reducing factors and investigation is relevant.

If an "older" couple, where the woman is over approx 37 years do not become pregnant within a year, they risk losing important time. As the woman ages it becomes much more difficult to get pregnant, so this is where research is relevant.

Faster referral may be reasonable if there are obvious fertility-reducing causes, for example, that the woman has no cycle at all or that the man has received chemotherapy that may have damaged sperm production.

The reference:

Here you will find a link to relevant tests and blood tests in Danish for both the man and the woman.

When the couple arrives at the clinic:

We always start with a conversation where we go through studies that have already been done and any previous treatments. We do gynecological ultrasound scans. If necessary, supplement with further studies. Types of treatment and options are reviewed.

For the heterosexual couple, insemination is started if the sperm sample contains more than 2 million progressive motile sperm cells after "purification" and if there is normal HSG (possibly HSU). Pergotime and / or FSH will often be used for follicle stimulation.

Single women and lesbian couples start with insemination with donor sperm if tubal conditions are in order.

There are several options for donor sperm:

Anonymous donor: Here you specify eye color, hair color, height, weight and skin color.
Extended profile: In addition to the above, this profile contains few information, such as blood type or more detailed information about childhood, family relationships, occupations, hobbies, education, voting, baby photos, etc.
Open donor: The "open" donor has entered into an agreement with the sperm bank that donor children can contact their donor when they turn 18, if they wish.
Known donor: A "known" sperm donor is a donor that the woman / couple themselves know and who has agreed to donate semen for artificial fertilization of the woman, even though the woman and donor are not married or forming a couple. The "known" donor has a dependency obligation on the child, and the child has inherited from the "known" donor.

In Vitro Fertilization:

Test tube treatment is used as primary treatment if, after investigation, it is obvious that the chances of getting pregnant through "homework" or insemination are poor. It may be due to closed tubae or due to severely impaired sperm quality.

Test tubes are also used as second-line therapy if pregnancy has not been achieved after 3-6 insemination treatments (depending on the cause of infertility).

It can be stimulated in a short protocol (stimulation with FSH from cycle day 3) or a long protocol (downregulation with GnRH agonist from cycle day 21 for 2 weeks and then stimulation with FSH).

IVF (without microinsemination) is used when the quality of the semen sample is deemed suitable for fertilizing the eggs.

ICSI (microinsemination) is used for severely impaired sperm quality, where, in experience, the sperm cells cannot directly fertilize the eggs.

Egg collection

The egg collection itself usually lasts 10-15 minutes and is practically painless as the woman is injected with fast-acting morphine-like preparation (rapifen) during the procedure.

In the laboratory:

IUI: The semen will be delivered in the morning. The sperm are purified by gradient centrifugation and prepared for insemination. Is brought up into the uterus with a small catheter.
IVF: 100,000-150,000 sperm are added to each oocyte. Then store in incubator with carefully regulated temperature, CO2, O2 and humidity content.ICSI: A single sperm is injected into each oocyte. Thereafter, the fertilized oocytes are also stored in the incubator.

Transferring / embryo transfer:

Takes place on day 2, 3 or 5 (blastocyst) after egg collection. As a starting point, one embryo is recommended for women under 36 (1st and 2nd cycle). Implantation of two embryos is recommended for reduced embryo quality, females over 36, at the third cycle and using thawed embryos.

Pregnancy Chances:

IUI: Pregnancy chance of insemination is approx. 18-20% when the woman is under 40. If the woman is over 40, the chance of pregnancy is approx. 10-14% per treatment.
IVF / ICSI: The chance of pregnancy with tube glass treatment depends on the woman's age, the number of eggs laid and the length of time the eggs have been grown. Here you will find our results for IUI and IVF / ICSI.

Visiting?

We have had several GPs and specialist doctors visiting the clinic and everyone is very welcome. Write to Kåre Rygaard at kry@trianglen.dk or call +45 39 40 70 00 to make an appointment

Didn't find what you were looking for?

So please send your own question to us at info@trianglen.dk.