IVF ICSI Fertility Treatment

IVF ICSI Treatment or IVF ICSI Fertility Treatment 


IVF-ICSI-Treatment

is a comprehensive fertility treatment in which many people are involved. Some of them you will regularly see, like fertility doctors, the nurses, the echografisten, and medical secretaries.

Others, such as the clinical embryologists and analysts are behind the scenes just as hard for you to work. There are also gynecologists and social workers to the team linked, with whom you may be in contact.

The medical secretaries are working in the secretariat of the clinic. They allow you (telephone) to talk and can include helpful in making appointments with doctors.

During your treatment echoes created to monitor how the ovaries respond to the medication. These echoes can be performed by a sonographer, nurse, and doctor.

Each pair receives the first appointment at the clinic with a fertility doctor. This doctor is your doctor and continues during treatment your permanent contact. The other doctors you probably know well. IVF ICSI treatment is indeed a treatment continues seven days a week.

The nurses perform many tasks, including creating echoes, assisting in surgeries, the telephone transmission of results and giving instructions prick.

In the laboratory work to emerge, analysts and clinical embryologists with your sperm and egg cells to embryos. The best embryos will be selected and should lead to a pregnancy after placement in the uterus.

Finally, a social worker is ready to assist you if you are in need.

Overall, an IVF ICSI Fertility treatment is done by a team that determines in close consultation with each other and with you what is the best way for you to achieve the desired goal.


The natural conception


IVF-ICSI-Fertility-Treatment


Each month, from the beginning of menstruation, start growing in the ovaries to mature follicles and oocytes. Such an egg is microscopic in size and is surrounded by an ever-increasing is becoming ovarian follicle, which is filled with fluid (the follicle). Usually grows every month only one of the eggs and go through the other lost.

With ovulation (ovulation), this follicle bursts open and the egg is free. With a regular cycle of 28 days, the time of ovulation in approximately the middle between menstrual periods. The still unfertilized egg is picked up by one of the fallopian tubes. The sperm reaches the community in the sheath and swims in less than 5 minutes from the uterus through the fallopian tube toward the egg.

In the fallopian tube to meet the egg and sperm together and fertilization takes place there. The egg then merges with sperm. The fertilized egg is dividing and is now called embryo transfer to the uterus in about four days. In the lining of the uterus then find the embryo implantation site. Not all of these steps are always successful. In a natural cycle is on average 10% chance of pregnancy.


People eligible for IVF ICSI Fertility treatment

IVF / ICSI is a medical treatment. To qualify for this to come, there must be a reason, a (medical) indication.

In the development of IVF treatment, there was only one indicator, namely when the woman there was tubal. Nowadays doctors often do IVF / ICSI when semen quality is not optimal or if there is severe endometriosis.

Even if no cause is found for the lack of pregnancy and other treatments have not been successful, there may be an indication for IVF ICSI Fertility treatment. Also, egg donation is an indication for an IVF ICSI treatment.

IVF ICSI treatments done to the woman reaches the age of 43. This limit is set, because it appears that the chances of a good pregnancy after this age has become very small.
After each treatment does not lead to a pregnancy looked at anyone whether it makes sense to start a new treatment.

For men of couples who want to undergo IVF ICSI treatment, an age limit of 60 years is maintained.


IVF ICSI treatment

IVF-Fertility-Treatment

IVF ICSI Fertility Treatment procedure-


An IVF ICSI Fertility treatment consists of four successive stages.


1. The hormonal stimulation.

The ovaries are stimulated with hormones so that there are more mature follicles than normal. The aim is to obtain about 8 to 10 eggs. With this number of oocytes usually, creates multiple embryos. With multiple embryos is possible to select the best embryo, most pregnancy rate, and freeze the remaining good quality embryos for later use.


2. The "ovum pick-up" (the puncture)

The ovaries are under ultrasound-guided picked and sucked empty follicles through the vagina. The moisture from the follicles is collected in tubes. With the fluid from the follicle comes with the oocyte.


3. The laboratory phase

In the laboratory, the oocytes are removed from the fluid and stored in an incubator at body temperature. The oocytes are fertilized by the IVF procedure (the most motile sperm cells are combined with the egg cells), or with the ICSI procedure (one well-motile sperm is injected into the oocyte).

One day can be seen later whether fertilization has occurred. After that, the division of the embryo in the lab takes place.


4. The embryo transfer (reintegration)

Usually, three days after the puncture can find a replacement of an embryo in the uterus in place. With a thin tube (catheter) is placed an embryo into the uterus through the vagina and the cervix.

Nowadays more and more often replaced just one embryo. Sometimes two embryos are transferred. In this, the age of the woman, the quality of embryos and the medical history involved. There are never more than two embryos replaced.

After the replacement is a difficult and tense period of waiting.


The preparation of treatment

Before starting treatment, you have a conversation with one of the fertility doctor. In this conversation, you and your partner are both presents.

In the interview, you will receive detailed information and instructions about treatment and doctors make sure you have done all the necessary research (including infection screening for hepatitis B, C and HIV through blood). Doctors also determine when you can just start treatment.

An output echo agreed and made an appointment for an injection instruction by the nurse.
The exit echo is to see if there are no circumstances (e.g., the presence of a cyst in the ovary), which may prevent the onset of treatment.

The woman is advised to begin a month before the start of treatment with the use of folic acid (one 0.5 mg tablet daily). This reduces the chance of a child with spina bifida. Also advised by the Health Council to swallow ten micrograms of vitamin D. You can get both drugs without prescription at the pharmacy.


Treatment with hormones


ICSI-Fertility-Treatment

To grow several eggs in the ovaries, hormone treatment is needed. By obtaining several eggs will increase the chances of fertilization and pregnancy rate. The drugs used are below each one includes:


  • Synarel / Decapeptyl or Cetrotide
  • FSH (follicle stimulating hormone) containing compositions: Gonal-F, Puregon or Menopur
  • Ovitrelle or Pregnyl
  • Utrogestan

What combination of medications you are prescribed and which format you use the medication, you will be notified orally and in writing by the fertility doctor.

All medications must be injected, can be administered via subcutaneous injections. Because you need an injection almost every day during the treatment, it is very useful when you can inject yourself or your partner. For this purpose, will be arranged an injection instruction to the nurse.

Anyone can learn it. The injections should be prepared and how to inject, will be explained during the injection instruction.

If you forget a medicine of said groups one or two a day during stimulation, please always contact your doctor about whether or not to continue further treatment.


Synarel / Decapeptyl or Cetrotide

To ensure that the FSH formulations work well, it is necessary that the operation is not disturbed by your hormones. The operation of the own hormones can cause premature ovulation and reduce egg quality. Synarel or Decapeptyl are the most commonly used drugs to inhibit its hormone production.

You use this medication daily from the start of treatment until the eggs are matured (and turn the final injection of Ovitrelle (see below)). Synarel is a nasal spray, which is two times daily is to be used. Decapeptyl should be 1 x daily to be administered via a subcutaneous injection.

You can personally make a choice between these two agents. Also, Cetrotide is a means that holds a premature ovulation, and 1 x daily is to be administered via a subcutaneous injection.

Even if you have a cold, Synarel works, but it is recommended to blow your nose before use. Decapeptyl and Cetrotide be stored in the refrigerator. Synarel may just not in the refrigerator.


FSH preparations

Several FSH preparations on the market with a similar effect. Currently prescribed for Gonal-F above doctors. These hormones allow multiple eggs at the same time to develop. Gonal-F is administered in the form of an injection under the skin (subcutaneous) and is available in a user pre-filled pen.

After commissioning, the pin 28 days.

How it happens, injection is discussed during prikles. The dosage and the day of starting the stimulation will be notified by your doctor.


Ovitrelle or Pregnyl

An injection of Ovitrelle or Pregnyl is used to mature the eggs in the follicles. Approximately 40 hours after the administration ovulation occurs.

At the indicated day and time to inject Ovitrelle 250 micrograms or Pregnyl 10,000 units (two ampoules of every 5,000 units). On this day, spray no more Gonal-F. However, you use this day still on the (last) usual time the Synarel, Decapeptyl or Cetrotide.

The time between the injection Ovitrelle / Pregnyl and the puncture is 36 hours. This means that the injection evening or sometimes should be given at night. If someone else administers the injections (e.g., general practitioner), this can be a difficult time. Consultation is therefore timely.

The time between administering the last injection and the removal of the ova listening very closely. The injection must be administered exactly at the time that you will be notified. Is the injection given later than the appointed time, the eggs can not mature and are not even released at the time of the puncture.

Is the injection given before, chances are that some eggs already jumped from the follicles and therefore they can not all be absorbed by us. When more than half an hour you depart from the time specified by us to you on the day of the puncture contact your doctor.

Note: Always check the ampoules you get from the pharmacy to the correct units. Pregnyl is namely ampoules of 5,000 and 1,500 units.


Utrogestan


The day after collecting the eggs is known whether fertilization has occurred. If eggs are fertilized, starting from this evening using Utrogestan. This agent is a progesterone-containing preparation.

The hormone progesterone makes you usually themselves and serves the endometrium, where the implantation takes place, in bringing and keeping the right condition. You get this medication because your hormone production is shut down by the Synarel, Decapeptyl or Cetrotide and therefore itself sometimes makes too little of this hormone.

The Utrogestan capsules work in IVF ICSI Fertility treatment is best when they are inserted into the vagina (the leaflet otherwise!). Three times a day (morning, afternoon, and before going to bed) serve two capsules to be inserted into the vagina. You continue this process until you get further instructions from us. Utrogestan may be stored in the refrigerator, but can also be stored under the 25⁰C outside the refrigerator.


Side effects of the medications

Each of the above medications can cause side effects. Relate to mild side effects, which are not as highly annoying. Below is the most common side effects are described.

Synarel, Decapeptyl, and Cetrotide give flushing and sometimes a slight headache. During the stimulation can retain moisture and thereby increase your weight. You can also respond emotionally intense than you expect from yourself. Some women feel uncomfortable or sad; others feel just fine. You can have an unexpected moment in the cycle of blood loss. This may be caused by the medications and need not have a negative effect on your treatment.

After the injection of Ovitrelle / Pregnyl can sometimes suffer from sensitive swelling at the injection site. This is not serious, and the drugs do work correctly.

While using Utrogestan, you get (more) suffer from separation. This is completely normal as long as there arises no itching or irritation on. Utrogestan can also emulate a feeling pregnancy (nausea, breast tenderness) while this might not. This can be very confusing.


The treatment regimen


ICSI-IVF-Fertility-Treatment

During the treatment, you get to deal with the hormone stimulation, ultrasound checks, telephone instructions, the puncture and other important moments that follow there again. These steps are summarized in the table below.

By your doctor, you will be scheduled in one week before the start of an IVF ICSI treatment. This planning is done by your menstrual cycle. Before it started treatment, should be made an output echo. This usually takes a month before the start of the stimulation site and if possible combined with a puncture instruction.

If the echo no abnormalities are found, you can start at the start of the next menstruation with IVF ICSI Fertility treatment.

On the first day of menstruation, call your doctor to inform that you are going to menstruate and to make an appointment for a first echo control in the IVF / ICSI stimulation.

From the first day, you start using Synarel (2 x daily one puff) or Decapeptyl (1 x 1 daily subcutaneous injection). From the 4th day, is also started on the default schedule with the administration of Gonal-F (1 x 1 daily subcutaneous injection). The injections you need at night to use about the same time.


The echo and blood tests

The best and most widely used method of ultrasound in IVF ICSI is vaginal ultrasound. Here, a rod-shaped ultrasound probe (which transmits the ultrasound sound waves and captures) is brought into the vagina. Because of the uterus and the ovary containing the follicles means of these sound waves are visible on the screen.

The ultrasound examination is usually painless and works best if you have an empty bladder. The sonographer measures the thickness of the endometrium, counts the number of follicles and the size of the follicles in the ovaries. During the successive echo controls, the growth of the follicles can be determined.

On the day of the echo-control of blood is also collected from the Central Blood (C2). Labkaart for a decrease in the blood you receive from the Secretariat gynecology if you report to the echo. The hormone levels in the blood also give a measure of the reaction to the medication used.

There every day made a new appointment for echo and blood tests, and repeat this appointment is a piece or 4 or 5 times until follicles are large enough to arrange the puncture. It can also happen that someone violently reacts to the medication, which is required daily monitoring.

It is therefore not possible beforehand to schedule appointments for blood tests and ultrasound. If you for the next appointment preference for a certain time or on a specific day or time just can not get, indicate this at the secretariat when you report. We will try to take this into account.


Ready for the puncture?

If the ovarian response was successful and the follicles have reached a nice size, the puncture can be agreed upon. On average, a puncture around cycle day 14 instead. Some women, however, are on cycle 10 ready for a puncture, in others, it is perhaps only on day 20. You will hear from us when the last day is that you Gonal-F to spray and when to injection of Ovitrelle or Pregnyl put.

It may also happen that your response to hormones is too intense and it is not justified to continue the puncture. Also, it may happen that the reaction is too low and that the puncture is not performed for this reason.


Collecting the eggs (puncture)

The egg collection (the puncture) takes place in a specially equipped treatment room. Your partner (or supervisor) can be present at the puncture. You can bring your CD with music that you feel comfortable with.

You've heard us what time you and your partner are expected at the IVF clinic. You do not need to fast; you just have breakfast. Half an hour before the puncture you get a tablet and an injection well to be relaxed and as little as possible to feel pain during the procedure.

The medication you are "under the influence, " and you should not drive yourself home by car.

The lower body is covered with clothes. After that, given a local anesthetic in the wall of the vagina. On the cover of the echo, then the follicles are punctured and sucked dry in the ovaries. Puncturing the follicles usually easy, but despite the anesthetic can still be painful.

Piercing takes several minutes. The fluid containing the oocytes is collected in tubes. The eggs are retrieved in the IVF laboratory. After the procedure, you will remain a lie and say about 15 minutes later, how many eggs have been found.

After the procedure, you can go home again. Once home, you need to take any special measures. Often you feel some dull and sleepy. You can still feel pain after the puncture. It is therefore wise for the rest of the day to slow down and to have no further obligations. In pain, you can use acetaminophen as needed (up to 3 times daily 2 tablets of 500 mg).

When the puncture, there is a risk of bleeding, and it was inserted, for example, the intestines. Incidentally, this is extremely rare. In some situations, there may be an increased risk of infection after the puncture. If this is the case, you will receive from the day of the puncture antibiotics.

Production

The man must produce on the morning of the puncture seed through masturbation. Abstaining about three days is recommended for the puncture. Langer is useless and may even be detrimental to sperm quality. It is important to wash hands and penis before and especially good rinse with water (soap residue can harm sperm!).

The best just can produce at home. For this, you are given a sterile container with the Secretariat. It is important that you only a sterile container that you previously used inherited the outpatient gynecology for maintaining the quality of the seed.

If you, unfortunately, the day is not owned by the puncture of this game, you can produce seed in the hospital. Even if you live far from the hospital, you can produce seed in the hospital. This is only required if there are more than two hours between the time of production and return it to the lab.

If you have had an infection in a testicle or the urinary tract in the last two months for treatment, if you have gone through an illness with high fever in that period, or you are taking medications (such as antibiotics) used since the last seed analysis requests we will respond as soon as possible to notify us. It could be that the seed quality is diminished by the disease and medication.

We can then check before or at the beginning of the IVF ICSI treatment seed again. The treatment may be delayed until the seed quality is restored.

Transporting
the pot with seed is not too cool and not be carried too hot (15-20 ⁰C).

Submitting the seed
the pot with seeds and its sperm will form on the day of the puncture in the IVF laboratory.

The corresponding sperm form, the name, and date of birth of both you and your partner are. The sperm must form you filled in under the heading: "Fill by the patient." This refers to the date and time of production, and to indicate whether the production and transportation, according to the instructions given are expired.

If this is not the case, please indicate how the instruction is waived. The IVF laboratory employee will receive the game and the form and view whether the form is properly completed.


Frozen sperm

If it is made from frozen sperm use, the laboratory ensures that the seed is thawed on the day of the puncture.

You know from experience that producing seed for you can be problematic, report it on time to your fertility doctor. Even if you are often absent from work, it makes sense to discuss this. Perhaps it may be wise in this case to freeze before initiation of treatment seed. In general, fresh seed is preferred.


IVF or ICSI



ICSI-IVF-Treatment


As previously mentioned, the IVF and ICSI treatment for you as a patient alike. The difference is in the laboratory stage. In IVF, the sperm swims in a drop of broth itself to the egg, after which fertilization can occur. In ICSI is sucked one of the best moving sperm with an extremely thin glass needle and into the egg.

This procedure is necessary if the sperm is unable to penetrate them into the oocyte. In IVF, this part extends naturally. The introduction of sperm into an egg does not mean that there is always fertilization occurs. After application of both IVF and ICSI is fertilized about 65% of the oocytes.

In ICSI can not be inserted all at one sperm obtained oocytes. This can only eggs that are fully ripe. Also, not all the eggs will be passed the injection.

It may also be that some oocytes being treated with ICSI and a plurality of the IVF procedure. All this can be different for each attempt and will be discussed with you. If notice is clear that you are eligible for ICSI, this will be discussed at the clinic with you and gets you about additional written information.

The actual fertilization


IVF

On the morning of the puncture is started for editing seed. The most moving sperm are selected. At the end of the day will be a large number of pre-treated sperm in each oocyte. The next day will see whether the eggs are fertilized.


ICSI

The above is largely applicable to the ICSI treatment. Extra is that the eggs are removed from the support surrounding tissue after the puncture. This is to see which egg cells are mature. Only mature eggs were suitable for injection with sperm.

Sometimes occurs in IVF ICSI Fertility treatment no fertilization. This is obviously a big disappointment because it is already clear that you will not become pregnant in the treatment cycle. Depending on the cause, if we can give all, we will discuss with you what this means for your further treatment.


Embryo transfer (embryo transfer).


Replacing an embryo is usually painless and takes place on an outpatient basis. The cervix with the aid of a duckbill (speculum) imaged. Next, a thin tube (catheter) is introduced through the cervical canal into the uterine cavity.

Through this tube is the embryo with a very small quantity of liquid placed in the uterus. When the bladder is half full, replacing is easier. After embryo transfer, you may do whatever you normally do. You will receive an appointment to carry out a pregnancy test (blood test).

You also receive some initial reintegration an appointment to talk with your IVF physician.


The one-embryo policy

By replacing multiple embryos admittedly increases the likelihood of pregnancy, but the risk of multiple pregnancies (twins or triplets) is considerably larger.

Multiple pregnancies carry greater risks for the mother and the children than a singleton pregnancy. So the mother has a higher risk of pre-eclampsia and hypertension and is in childbirth often talk of an assisted delivery (vacuum, cesarean).

When children come mainly preterm birth and low birth weight, with the associated risks, more frequent. Some children are born prematurely, do not survive. Others may have left here mild to severe handicaps (e.g., motor disorders, learning and behavioral disorders). Most twins are the happy, healthy world.

IVF / ICSI results are constantly examined. It is known that many factors affect the risk of pregnancy, the risk of miscarriage and the risk of multiple pregnancies. These include:


  • Age of woman
  • Watches for men and women
  • previous pregnancies
  • Result of the preceding IVF ICSI treatments
  • Number of available embryos
  • Speed of division and the quality of the embryos
  • Availability of embryos for freezing and thawing


In connection with the increased risks of multiple pregnancies is aimed at an IVF ICSI treatment for a singleton pregnancy. By taking into account the above factors and increasingly replacing a single embryo, the rate of multiple births has decreased significantly.

It has been found that by freezing, thawing, and re-inserted high-quality embryos the opportunity to end to become pregnant, is not reduced.

Freezing of embryos

Freezing of remaining embryos is possible in principle, but not every embryo is suitable for freezing and storage. The condition for the freezing of embryos is that the fulfillment of the requirement infection screening. Rules should also for freezing embryos signed by both patients and have been submitted.

Practice shows that at about 60% of the IVF ICSI Fertility treatments remaining embryos are suitable for freezing.

When the re-insertion is known, or embryos can be frozen. Sometimes it is on this day not be said with certainty. You will be in this case a day later called to see if freezing could still occur.

Frozen embryos can thaw in a subsequent cycle, and will be replaced. This is usually done in a spontaneous cycle, i.e. without stimulation.

The course of pregnancy after using frozen and thawed embryos is similar to normal pregnancy, and the health of children born after such a pregnancy is not affected by this procedure.

If embryos are frozen and no pregnancy occurs after replacement after a puncture, will then be first to thawing and transfer of the frozen embryos passed before a new IVF ICSI Fertility treatment can begin.


The period after replacement

The following period of about 14 days is an exciting and uncertain time. At the end of this period will show whether you have become pregnant or not. You have been given instructions on paper in the reintegration and date a pregnancy test (blood test) will be performed.

Realize that medication use can cause pregnancy symptoms, while there may be no pregnancy. This can yield confusing feelings.

Even if you already bleeding and thinks the treatment is not successful, we always want to let this investigation take place. Sometimes prevent blood loss during implantation or fit an ectopic pregnancy. It is therefore very important for your safety that you adhere to the appointment of the blood test. On the day of the pregnancy test comes in the afternoon by phone the outcome.

All in all, it is a great disappointment when after waiting for two exciting weeks show that you are not pregnant. A lot of questions can arise in the days following the negative outcome. Allows you to ask your fertility doctor during the discussion afterward. Menstruation can occur during use or after stopping the Utrogestan and in some cases more severe than usual. For complaints or questions, please contact a fertility doctor or nurse.

If the result is positive, a second blood test will be agreed with you. Also, you should have about three weeks to continue Utrogestan. Here you need a refill for that you get the nurse if you come for the second test. If this result gives another good positive results, will be made an appointment for ultrasound examination.


Precautions during and after treatment

Sports can and may during an IVF ICSI Fertility treatment. As the stimulation progresses, the ovaries grow and can be quite sensitive. From this moment, we advise against strenuous exercise.

After replacement sports has no negative impact on the chance of becoming pregnant. After the puncture, however, the ovaries still swollen and fragile and are advised to wait for strenuous exercise until you have absolutely no complaints.

Sex is permitted during the stimulation. Keep in mind that for the puncture, and thus for the return of sperm is recommended three days abstinence, so that the sperm quality is optimal.

After the puncture sex is not recommended until you have no more vaginal bleeding and symptoms of sensitive ovaries are no longer present.

Vacation plans just after replacement can be inconvenient. The pregnancy test is also intended to rule out an ectopic pregnancy, and if there are complications after treatment are needed additional controls. Six weeks after the puncture, it is almost always possible to travel.


ICSI IVF Success rate


IVF-ICSI-success-rate

The chance of successful IVF ICSI treatment and a child is born, is not equal for everyone. There are many factors that determine whether the effort will ultimately succeed or not.

The odds may be expressed per started attempt or instance per reintegration (= a complete treatment). Furthermore, one can talk about child birth or just an early pregnancy. Nationally, the result is expressed in the risk of an ongoing pregnancy rate per initiated treatment. This shall include the pregnancies after freezing and thawing counted.

Of the IVF ICSI Fertility treatment initiated patients has been 60% one or more children.
The final chance of an IVF attempt succeeds or not depends mainly on whether there is a good sharing embryo can be replaced. To obtain multiple good and rapidly dividing embryos but go many steps in advance.

At each step in the treatment may be something against or there are factors that positively or negatively working, but where nothing is changing. Examples of this are:

  • Too violent response to hormone stimulation, causing the puncture must be canceled.
  • Inadequate response to hormonal stimulation (sometimes even premature discontinuation of treatment effect).
  • Ovulation can, despite the use of Synarel or Decapeptyl, all action for the puncture and it can therefore not go through because no eggs can be found.
  • Inferior quality of sperm.
  • Limited or no fertilization of the ova.
  • Less good or less rapid division of embryos.

Most treatments involve a reinstatement, but then still often does not occur on implantation. This is usually a designated cause. A pregnancy rate of 30% per reintegration means that out of every three two attempts fail and only one well.

For everyone is that we seem not sensible after each treatment you discuss whether continued treatment. You can not assume that all three (the number of treatments, which reimburses the basic insurance in 2015) can be treated.


Age and the likelihood of successful treatment


With the increasing age of women reduces the risk of pregnancy, including through the reduction of the number of oocytes and the quality of the eggs. Consideration will be given to indicate whether any adjustments should be made in the treatment (e.g., change in dosage and the starting day of the medication).

Also, no new IVF ICSI treatment started more after the 43rd birthday of the woman.
Besides the fact that the chance of pregnancy decreases with the age of the woman, the risk of miscarriage with increasing age increases.

In an IVF ICSI Fertility treatment is the average probability of a resulting pregnancy the birth of a child leads approximately 70-75%. In younger women is most likely that the pregnancy is going well, but in women around 40 years, this chance drops to about 65%.


How to influence the chances of success?

You can do several things to improve the chances of a successful outcome of the treatment. This section discusses these issues.

It is known that obesity in many ways may reduce the chance of successful treatment. In men, it reduces sperm quality and therefore the chance of fertilization. In women, excess weight reduces the risk of pregnancy and thereby increases the risk of spontaneous miscarriage. During pregnancy, there is also an increased risk of complications such as high blood pressure.

There is also an increased risk of a too small or too big kid. In both cases the child in later life a greater risk of experiencing health problems compared to children with normal birth weight.

Overweight is calculated by two factors, the weight, and length. The degree of obesity can be determined by the body mass index (BMI), also known as the Quetelet Index. The BMI is calculated by dividing body weight in kilograms by height in meters, and this outcome to share one more time by the height in meters. When the BMI is above 25 kg / m 2, there is overweight.

If the BMI is above 30 kg / m2, you first need to fall off before it can be started with treatment.

Also, smoking by men and women reduces the risk of pregnancy. It indicates damage to blood vessels, which are necessary for implantation and the formation of the placenta. Smoking during pregnancy is more likely a spontaneous miscarriage and ectopic pregnancy.

A detachment of the placenta and small children are more often seen in smoking mothers. When smoking men is often a reduced sperm quality.

Of alcohol are also adverse effects on the pregnancy and development of the unborn child known.

Doctors advise both parties at least three months to stop well before and during treatment to stop the initiation of treatment with smoking, drugs, and alcohol.


Stop or continue?

After each treatment, you have an evaluation by your doctor.

If you, unfortunately, can not become pregnant, will be discussed at this meeting how the previous attempt has expired and what, if anything went wrong. Is also discussed here or (medically) makes sense to continue with further treatment or stop better.

If you would like to be further treated, will be discussed with you what, if anything needs to be changed, and when a subsequent treatment can take place. If desired, a break can be inserted into the treatment.

As previously discussed, it is not advisable for anyone to undergo three IVF ICSI Fertility treatments (the number of which is now covered by the basic insurance). Then after three treatments, it may still be worthwhile to continue. Treatment and concomitant medication you should pay yourself. After six treatments without pregnancy is usually not worthwhile to continue.


Average IVF ICSI results

As mentioned earlier in this folder there are many factors affect the success of IVF ICSI treatment. The subsequent list is intended to give an impression of the average pregnancy rate, multiple pregnancies, and an improperly sloped pregnancy.

For each pair will, therefore, influences separately, so you have this more or less likely. The odds are calculated as the probability per attempt started. It is also shown that there is a difference between an early pregnancy, as established for a pregnancy test and a good ongoing pregnancy, which eventually leads to the birth of one or more children.

It is compiled with data from 2010 to 2014 at the Leiden University Medical Center, and Clinics Transportation IVF and ICSI patients treated.

IVF / ICSI results 2010 t / m in 2014
Number launched efforts  4035
number of pregnancies  1838 (45.6%)
Number of ongoing pregnancies  1309 (32.4%) (= 71% per pregnancy)
Of these pregnancies originated 34.1% after freezing, thawing and replacing embryos.

In a resultant pregnancy after IVF ICSI Fertility treatment, there is 74.0% existence of an ongoing pregnancy.

What is important to know that fewer embryos are transferred at a time. The use of freezing and thawing of the remaining embryos, the pregnancy rate per initiated effort declined, but the number of multiple pregnancies though.

The risk of eenling- or multiple pregnancies (2010 t / m 2014). Number of pregnancies (probability per ongoing pregnancy)
singletons   1309 (95.2%)
Twins  63 (4.8%)


Risks and complications

Over-stimulation (OHSS)

Over-stimulation is the term by which the ovarian hyperstimulation syndrome (OHSS) is meant. Every woman is treated with hormones as part of fertility treatment runs a certain risk of overstimulation.

Especially if there are many follicles grow and hormone levels are very high in the blood, the risk increases. The symptoms of overstimulation usually occur until after the puncture, often only after replacement. Symptoms include abdominal pain, abdominal distension, weight gain and feeling sick.

Take your weight after Ovitrelle or Pregnyl injection of more than 2 kilograms, and you get increasing abdominal pain despite rest, drink plenty of fluids and paracetamol, please contact your doctor. The doctor will assess whether you should come along for an additional echo and blood tests. This allows the severity of over-stimulation can be determined.

Usually, it is sufficient to outpatient control. Also, rest, drink plenty of fluids and paracetamol use is important to diminish the symptoms. Only very rarely is it necessary to take someone (this is primarily intended to prevent clotting disorders (thrombosis))?

Doctors obviously want to minimize this situation. Doctors do this by dosing as low as possible and to carry out frequent checks during stimulation. If during the stimulation that (too) many follicles grow and hormone levels (too) high will then be decided not to puncture because the risk is too high an overstimulation.

If found in very many ova punctures, you will receive instructions with the fertility doctor to quickly identify possible overstimulation and, if necessary, treated.


Multiple pregnancy

Multiple pregnancies occur after IVF ICSI treatment. Average of 5% of the ongoing pregnancies in the is a multiple pregnancies.

Although the chance of multiple births is minimized by appropriate transfer policy, it is still important to think about this with your partner before the start of treatment and if necessary in time to talk to your fertility doctor. For multiple births usually involve twins. Because there also appear identical twins, there is a tiny chance that a replacement of two embryos results in a triplet pregnancy.

Multiple pregnancies carry significantly more risk-taking than singleton pregnancies, mainly preterm birth, and short and long-term all consequences.


ICSI risks

From the data that have been known up to now, it appears that the risk of birth defects in ICSI is hardly any different from that at other pregnancies.

However, it appears that there is a slightly increased risk of having a child with an abnormal number of sex chromosomes (the X and Y chromosomes, which determine the sex). These are defects which also occur in spontaneous pregnancies. In ICSI pregnancies, these disorders more often, but still less than 1% of pregnancies.

You can get a written explanation of what exactly this abnormality and what the consequences are for a child with such a defect. Incidentally not involve life-threatening conditions.

Furthermore, it is increasingly clear that the quality of the seed is partly determined by some genetic factors in men. Men with these deviations can indicate this by ICSI to their sons. These guys may have later found a different seed quality. Whether this leads to reduced fertility in these children is unknown.


Other risks

As described there is at the puncture, there is a risk of bleeding, and the puncture of, for example, an intestine. Also, there exists a small chance of the occurrence of an infection.

Even with IVF ICSI Fertility treatment, there is a small chance of an ectopic pregnancy. In women with no fallopian tubes properly functioning or (partly) absent fallopian tubes, the chance is slightly larger (1 to 1.5% by replacement of an embryo or 4% per pregnancy).

About 20% of pregnancies seen after IVF / ICSI not go well and unfortunately end in miscarriage. This is often in the first weeks after you know you are pregnant.


Follow-up research

IVF ICSI Fertility treatment outcomes are constantly scrutinized. This to continually improve treatment and reduce risks. The purpose of the IVF ICSI treatment is of course that a healthy child is born.

The investigations extend to pregnancy, childbirth and if possible even later. Therefore doctors ask for your cooperation and understanding in case we later contacted by seeking to collect some data.


Accompaniment

Fertility treatments like IVF / ICSI can make great demands on the capacities of the pair. The fact that an IVF ICSI treatment is often the last chance of pregnancy, the uncertainty about the chances of success and the great effort of the treatment may be an additional burden.

Many couples load capacity can handle this uncertain period entails well together.

However, many couples face at one time or another with questions to which they do not directly answer to know. Often these questions concern:

  • Personal experience (fear and insecurity, guilt, burden of medical treatment, dealing with the medical world, interaction between body and mind)
  • Consequences for the relationship (experience of infertility, possible changes in the relationship can decide together whether or not to proceed with treatment)
  • Dealing with the environment (family, friends, colleagues, boss)
  • Values (own values, but also of the environment in which religion or belief may play a role)


The Pregnancy

Twelve days after embryo transfer a pregnancy test is performed. This is done using a determination of the amount of pregnancy hormone in the blood (a urine test will often still be negative at that time).

When the morning to eleven blood to prick you will still call the same day the results. If this test is positive, you will be asked again in a few days to do a test to assess whether there is an increase in the pregnancy hormone.

Of pregnancies ending nearly a quarter are ultimately determined in this way appears in an early miscarriage or an ectopic pregnancy.

A positive pregnancy test is a very good start, but it is still only the beginning!

If you are pregnant, you should continue to use the Utrogestan capsules (three times daily two capsules vaginally). After the second test you, if all goes well, make an appointment for a pregnancy ultrasound. This is a vaginal ultrasound to be performed about 5 weeks after the puncture.

This ultrasound we can see where the pregnancy is and whether there is a singleton or twin pregnancy. Usually, there already see a beating heart. If you have an ectopic pregnancy than the echo must be made a week before more risk for ovarian abnormalities. It is not always true that there can be seen a beating heart.

It is important first to determine that the pregnancy is in the right place.

After the first ultrasound usually follows an echo around the 10th week of pregnancy. You continue until approximately twelve weeks of pregnancy in our control. The gestational age is calculated in weeks from the puncture date plus two weeks. After these twelve weeks, the checks will be taken over by a midwife (or if indicated by a gynecologist).

It is important to continue to the first echo with Utrogestan. Also, the use of folic acid to the tenth week of pregnancy is important. It is also advised to take 10 micrograms of vitamin D.

During pregnancy, research can be done to birth defects. These include research on Down syndrome and research on physical abnormalities. After the first scan, you will receive more verbal and written information from your doctor.

Obviously, we like IVF team very curious how it goes with you and your pregnancy. Therefore, doctors will ask you to sign a so-called informed consent. This is a statement that you consent to us later, after pregnancy, to request information from the person who supervised your pregnancy and childbirth.

In this way, we hope to learn more about IVF / ICSI pregnancies and possibly other couples there later to their advantage.


The waiting time; treatment time

Before starting an IVF ICSI Fertility treatment is a waiting period that can vary throughout the year. For the interview with fertility doctor may be a wait. The actual start of treatment will be scheduled during the interview according to the menstrual cycle.

The moment of launch is further dependent on the studies that (any) to be made.

You can assume that you have during IVF ICSI Fertility treatments 7 to 15 consecutive days require daily injection. Also, you need about 5 to 7 times (echo and blood checks, puncture and replacement) come to the clinic in about two weeks. This can be difficult with your work. You must think in time how to arrange this. We try to take the utmost account of your needs, but also hope you understand that this is not always possible.

Once there has been an IVF ICSI treatment, but no pregnancy has occurred, often the question when it can be continued with a new treatment. The first cycle of a stimulation is, by definition, taken as resting month. During this period usually takes a talk with the doctor instead. This will be examined when a new stimulation or defrost cycle can be started.

Weekly start a certain number of women at the start of menstruation treatment. If your period is a week that is already fully planned, this means that a new treatment is feeding a month.


Finance

Currently, the first three treatments (including medication) fully compensated by insurance. Some health insurance companies reimburse a fourth treatment or more. It is therefore useful if you are already late inform your insurance about what is and is not reimbursed.

It is also useful to know what is meant exactly by your insurance under treatment. Sometimes treatment only counts as such when a puncture and replacement are performed, but often has a treatment such as on the first day of menstruation medication is started (whether or not there have been a puncture and reintegration).

The cost for an IVF ICSI Fertility treatment consists of two components, an amount for hospital treatment and the amount of medication. The height of the amount of the drug is dependent on the length and the height of the dosage of the medication.
The costs associated with the freezing and thawing of embryos and replacing thereof could be compensated for if they were supplied in a treatment that also has been compensated.


Defrost

If multiple embryos are of good quality embryos that can not be replaced, be frozen. Depending on the menstrual cycle is judged the best way to achieve thawing and transfer of the frozen embryos.


Natural cycle

If there is a regular cycle of between 21 and 35 days is often chosen for transfer to the own spontaneous cycle. The puncture in which the oocytes were collected, has been an artificial ovulation (ovulation).

Three days after the ovulation have frozen the remaining embryos. In the cycle you are scheduled to start with a defrost cycle will be started looking for ovulation and three days later will be passed to defrost. As a result, the current cycle is running is equal to the stage of development of the embryo.

The body will ovulate place. The oocyte that is released, there is no need for treatment, there is, after all, an embryo that will be thawed and placed back. After ovulation, however, remains a yellow body (corpus luteum) in the back of the ovary which produces hormones. This means that you do not use Utrogestan in this cycle.

It is important to determine the moment of triggering ovulation. To this end, there are some arrangements / investigations in this cycle.

The following information is based on a cycle of about 28 days. If your cycle is different here too much, will be agreed with you any changes to your treatment.


  • Around cycle day 13 echo and blood occurs (calling on the 1st day of menstruation the Secretariat to make this appointment). When the echo is looked at, the thickness of the mucous membrane and to the size of a developing follicle in the ovary. Also, there is a blood sample to see how the hormone is and whether ovulation is put in motion (the LH is increased before ovulation). Sometimes a single echo enough, sometimes there are several required.



  • From cycle day 11 you start saving urine. You need three times the day (morning, afternoon and evening) (crops) to collect urine in a jar. With a tube, you get the urine out of this game. In this tube, you paste a sticker with your information and fill in the date and time of collecting the urine. The urine samples should then be stored in a refrigerator. These urine samples can be defined as blood LH. The accumulated urine samples give you the day of echo and blood tests in the laboratory at H3. After the echo control, you need to continue earning urines. You hear the nurse when saving of urines is no longer necessary.



  • Ovitrelle / Pregnyl. In some cases, the use of Ovitrelle / Pregnyl is needed to trigger ovulation. You'll hear from doctors if you need to use the Ovitrelle / Pregnyl. Make sure you have the product at home when we call you at noon with the results of the echo and blood tests. In this cycle, there is no specific time to use them; you can if necessary use the Ovitrelle / Pregnyl evening at a time you prefer. Sometimes, there should be handed an afternoon and evening urine of the day the Ovitrelle / Pregnyl is injected. It is important only to inject Ovitrelle / Pregnyl after you have saved these urines.


Clomid- / FSH-supported cycle

In some cases, it is not convenient to look for ovulation in a completely natural cycle. This is often the case for women who have an irregular or a very long cycle. It may sometimes be necessary to support clomiphene citrate (Clomid) tablets to optimize the cycle. These tablets are from cycle day 3 to day 7 to be taken with.

The dosage may be 50, 100 or 150 mg per day. Also in this cycle should urine to be spared (see above) to detect an own possible ovulation. You hear from your doctor what dose to use, on the day you should come for the first echo and from when you need to start collecting urine.

Women who have an irregular cycle, but react insufficiently / not on Clomid, can sometimes by mild stimulation with FSH (Gonal-F / Menopur / Puregon) coming to ovulation. The dosage of the medication, the cycle day of the first echo and the time savings of urines will be considered by your doctor.


(G) EEP cycle

If a cycle is so irregular or non-existent, and thus to obtain an ovulation with the above means are not (or very difficult), can be chosen for transfer to a (G) EEP cycle. (G) EEP represents GnRH agonist Exogenous Estrogen and Progesterone. A (G) EEP cycle is a completely artificial cycle, wherein the stages are mimicked of a natural cycle.


Hormone tablets are used in a constructive scheme (Progynova 1 and 2 mg) to build on the mucous membrane. When the lining is thick enough, the 2nd phase of the cycle can be started to use Utrogestan. At that moment it is clear if it can be passed to de-icing of an embryo. Women themselves do not have a menstrual cycle EEP scheme. In women with an irregular cycle, it may be that the own cycle disrupts the EEP cycle. Then the thawing process is done.

The use of residual material

As part of your IVF ICSI treatment in your eggs and sperm obtained to achieve fertilization outside the body. The fertilized eggs are placed back after division into the uterus. If after replacement of embryos, is whether these are suitable for freezing. If so, these embryos were frozen. 

It may be that, in an IVF ICSI Fertility treatment, a part of the semen, and a part of the egg cells are not used. In the case of sperm, this can occur as a post-insemination (for IVF), or after injection (at ICSI), there still is about sperm. In the case of oocytes, this can occur in an ICSI treatment as eggs are immature and therefore not suitable for injection. Doctors call this "residual material." This residual material is often useful for (scientific) research into fertility disorders. 

Almost all the knowledge gained in the field of IVF and ICSI by medical research. In much of this research is residual material from patients used. This happens anonymised or coded. Anonymized is to say that the material is not traceable to the patient. Coded means that the material is indirectly traced to a patient. 

Research where your explicit consent is required, is done only if the Ethics Committee has given medical permission and after we have received specific permission from you. 

What do you have to do?

  • You need do nothing if you have no objection to the use of tissue for scientific research as described above.
  • If you do have any objections, please tell your doctor. This is then registered and forwarded to the laboratory so that the residual material is not used. This has absolutely no consequences for your treatment!

ALL THE INFORMATION PROVIDED IS CORRECT TO OUR KNOWLEDGE. BUT STILL, WE WOULD RECOMMEND CLEARING ALL YOUR DOUBTS WITH YOUR DOCTOR OR YOU CAN ALSO LEAVE AN COMMENT. SO THAT WE CAN ANSWER IT FOR YOU.
This is all about IVF ICSI Fertility Treatment, if you have any doubts please leave a comment.

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