When is IVF treatment indicated?

  1. When the female’s fallopian tubes are blocked or damaged as a result of pelvic inflammatory disease or appendicitis, history of Caesarian or abdominal surgery.
  2. Reduced sperm quality
  3. Endometriosis
  4. Unexplained infertility (all tests are normal in the male as well as the female)
  5. When the female or male has been sterilized
  6. Unsuccessful insemination with partner sperm or donor sperm
  7. Unsuccessful hormone stimulation or insemination in females with hormonal disturbances (polycystic ovaries)
  8. When the female is not yet 46 years (cf Danish Act on Artificial Reproduction)
  9. When the female is single or a lesbian

First consultation for females/couples to be treated with IVF
If you have previously received treatment for infertility in the form of hormonal stimulation or insemination treatment at a hospital or other fertility clinic, either public or private, it would be helpful if you acquired a copy of your medical records and brought them with you to the first consultation.

If you have previously been subjected to IVF treatment, we would also like to see your previous  “embryo growth charts”.

You are welcome to send them to us a few days in advance in order for us to assess your infertility history prior to our talk.

At the consultation we will write a chart on both of you and discuss the treatment you prefer and what you expect from any possible treatment. We will perform an ultrasound scan of the uterus and ovaries and then draw up a treatment plan.

We make every effort to match treatment with the individual patient/couple and dedicate treatment to your needs.

Females who have passed the age of 40 are advised to have a hormone analysis made on Cycle Day 2, 3 or 4 prior to the consultation at our clinic. This hormone analysis includes determining the FSH, LH and estradiol hormone levels and can be made at your GP’s. The purpose of the hormone analyses is to examine if the female is approaching menopause, which might have a significant impact on the treatment as well as the treatment outcome.

Please bring the test results to the consultation.

When can we start treatment?
When treatment should be made is entirely up to you. Very often you can begin treatment just after the initial interview.

Test for infectious diseases and vaccinations
According to the European  Tissue Act, all patients receiving IVF treatment are required to be tested for Hepatitis B and C and AIDS (HIV1and HIV2). If you have already had such tests made, please remember to bring a copy of the test results. Your name and a detailed description of the tests and the date of the blood sample must appear from the result, which should not be more than 2 years old. If you have not been tested earlier, we will collect the blood samples at the first consultation. We will not initiate any treatment before we have received the test results, which must be negative. Normally, test results are available within one week.

It is important that the female has either already had Rubella (German measles) or has been vaccinated against the disease at least three months prior to initiation of treatment.

We usually use two different treatment methods:

Re A. The advantages of the long-term treatment which is the most commonly applied form of treatment within IVF is that it typically results in the highest number of eggs and thereby also more useful embryos for subsequent embryo transfer. It is easy to plan, as pre-treatment of the ovaries included in the down-regulation procedures can be extended by a few days, rendering it possible to plan scans, egg retrieval, etc. well in advance based on the couple’s wishes. The disadvantage is that some females experience side effects from the down-regulation (see below).

Re B. The advantage of the short-term treatment is that it is of short duration and there is NO pre-treatment with nasal spray/injections and therefore no side effects. The disadvantage is that in general, the number of eggs is fewer and less uniform, which usually results in a reduced number of useful eggs compared to the long-term treatment. It is a little more difficult to plan as the initiation of treatment depends on the female cycle, as treatment already starts 2-4 days after the first day of her period. It is usually recommended to young fertile females in particular, where the male has reduced sperm quality or to females with few eggs.

We have chosen to describe the long-term treatment in detail below, as this is the treatment most couples prefer and the treatment we recommend, unless there are factors suggesting other action. The short treatment is described in the section on Frequently Asked Questions, click here.

Long-term treatment with nasal spray/injections

You can expect to come to IVF-SYD on the following days after the first consultation

However, on Cycle Day 21 and Stimulation Day 1 you need not come to the clinic on the exact day, but you are welcome to show up a couple of days before (but never after!) if you have problems coming to the clinic on that particular day.

Registering for treatment.
When you have been to the first consultation and talk, at which a treatment schedule has been made, prescriptions have been handed out and a contract prepared on treatment(s), the female may register for IVF treatment on the first day of her period (the first day when your menstrual bleeding persists from morning to evening, and you have to use either sanitary napkin or tampons, ie your bleeding is just not only spotting).

On this day, you must call IVF-SYD.

tel +45 76 24 50 20 from 9.15-12.00 a.m. or 12.30-2.30 p.m.

If your menstrual period arrives on a Friday after 2.30 p.m. or during the weekend, please call us on Monday or one of the following days during telephone hours.

We will give you a date and time for your ultrasound scan no later than 21 days after the start of your period (Cycle Day 21 if you have a 28-day cycle. If your menstrual cycle is either shorter or longer, treatment will start approximately 1 week before expected period).

Example:  26-day cycle = Day 19
                      27–day cycle= Day 20
                      28-day cycle= Day 21
                      29-day cycle= Day 22
                      30-day cycle = Day 23

Exception: Females with irregular menstrual periods, ie everybody with a cycle of more than 35 days between the start of periods as a result of polycystic ovaries must initiate pre-treatment with oral contraceptives from Period Day 1 in order to regulate their cycle. The females will therefore be given a prescription for Provera hormone tablets that are supposed to trigger the menstrual period as it will otherwise take months before a natural menstrual period starts. When her period commences, the female must initiate pre-treatment with oral contraceptives and then call the clinic and report that she is ready for treatment. Normally in this process, we see the female on Pill Day 18 and not on Cycle Day 21 as described above, but otherwise the process is the same.

In connection with this ”Day 21” scan you will be given an appointment for a consultation approximately 14 days later, when you must start with the hormone stimulation (Stimulation Day 1) and 8 days after (Stimulation Day 9), and you will be given a preliminary time schedule for egg retrieval and embryo transfer which are normally performed approximately 12-16 days after initiation of hormone injections.

Detailed description of treatment:

Cycle Day 21 (initiation of down regulation)
We will perform an ultrasound scan of your uterus and ovaries to make sure that this is the optimum timing for the initiation of the down regulation. At this point in time, the lining of the uterus must be thick and signs of ovulation in one of the ovaries must be present with the follicle having collapsed.

Women whose menstrual periods are irregular will typically start pre-treatment with three weeks on oral contraceptives and in this case, ovulation does not occur, but the lining of the uterus reacts to the oral contraceptive treatment.

You are given an instruction in taking the downregulation. If you have alredy purchased it, please remember to bring it with you. You should also bring your treatment chart (we call it a stimulation chart) which you were given at the first consultation.

How long you will be taking the down regulation is individually determined, but normally it is approximately 14 days.

You must take one puff of the nasal spray four times a day.

The puffs must be taken at equal intervals during the hours when you are awake, ie in the morning (as soon as you wake up), noon, late afternoon (eg for dinner) and at bedtime. It is a good idea to change between the right and the left nostril. If you miss a puff, you must take an extra puff the next time you remember to take a puff. If you are taking injections, you should take et once a day at almost the same time each day.

The effect of the down regulation
Pre-treatment with Suprecur/Synarela/Suprefact/Gonapeptyl inhibits the formation of the FSH and LH hormones in the pituitary gland. This reduces the risk of the female ovulating before a majority of the eggs are mature and can be retrieved for the purpose of fertilization in the laboratory. Therefore, it is important to continue taking the down regulation parallel to the subsequent hormone stimulation. You must take the down regulation for a total of three to four weeks.

Side effects of the down regulation
Side effects are rather rare and may present as transient hot flushes, nausea, headache, fatigue and irritability. These side effects are reduced if you remember to drink ample quantities of fluid during the daytime and make sure you get a good night’s sleep. The headache can be relieved with 500mg of Panodil (max 2 tablets x 4 daily)

Menstrual period after initiation of the down regulation
After the initiation of down regulation you may often encounter a bleeding similar to menstruation within the first 10 days. The bleeding may last a bit longer than you normally experience or can be followed by spotting for a few days. This is quite normal and often indicates that the medication is working.

If you have not had your period before the next scheduled consultation approximately 14 days after, you should call us.

This is very important as a visit to the clinic would be futile. We will then give you a new appointment as the missing period indicates that your own hormones have not yet been down regulated, which means that you will have to continue the down regulation one week longer than planned. This will by no means have a negative impact on the treatment outcome.

Cysts resulting from the down regulation
Sometimes, the delayed period is caused by a benign follicular ovarian cyst (fluid-filled bubble) forming as a result of the hormone treatment. Depending on its size, the cyst may cause some disturbance of the hormonal balance. Using an ultrasound scan, we will assess whether you should be subjected to one week’s additional down regulation as this will often cause the cyst to disappear, or if we should perform ultrasound-guided aspiration of the bubble. Cysts that form during down regulation are only empty follicles that grow, and they are completely harmless. Normally, they disappear by themselves.

Pregnancy during down regulation
In very rare cases, spontaneous pregnancy occurs immediately prior to the initiation of nasal spray treatment. If this is the case, there is an explanation to the missing period. Therefore, it is always advisable to have a pregnancy test made if you are experiencing a missed period. The down regulation does in no way affect the foetus.

Day 1 of stimulation (initiation of hormonal injections)
Once again, an ultrasound scan will be performed, this time to see if your ovaries and uterus have been down regulated by the nasal spray in order for the hormonal stimulation injections to be initiated. Some women are still bleeding at this point in time, which is not an obstacle for the scannning or the initiation of the hormonal treatment.

You will also be instructed in injection technique. You should start on the first FSH injection (follicle stimulating hormone: Gonal f, Pergoveris, Puregon or Menopur) on the same day or one of the following days. The day when you start the first hormonal injection is referred to as Stimulation Day 1. The hormonal stimulation must always be arranged individually and once treatment is initiated, we will inform you more specifically of the stimulation procedure in your case. This will appear in your personal treatment chart which is to be followed on a day-to-day basis.

A new scan will be scheduled approximately nine days after you started you FSH injections.

You should continue taking the down regulation, but at a reduced dosis.

Action of hormonal injections
The hormonal injections contain a follicle stimulating hormone (FSH) which enhances the formation of more than that one egg you would otherwise produce each month.

Side effects of FSH injections
The daily hormonal injections of the follicle stimulating hormone FSH may cause the skin to become slightly tender at the injection site. Some feel tension in their stomach in the days leading up to egg retrieval, the reason being that due to the many eggs, the ovaries take up more space in the abdomen than usual. Headaches may occur. You do NOT gain weight from the hormone therapy, but a great deal of fluid may build in your body as before your menstrual period. The fluid will always be secreted later via the kidneys and the urine once treatment has been completed.

Stimulation Day 9 (measurement of number and size of ovarian follicles)
You will be scanned again, during which procedure we will count the number of follicles and measure their size rendering it possible for us to determine the optimum timing of egg retrieval. In most cases, it is possible for us to plan at which time Ovitrelle, the ovulation injection, should be administered and when the egg retrieval procedure can take place. In other cases, the follicles are too small, and we will therefore tell you to continue your hormonal injections and return for a new scan after a few days.

You are thoroughly informed about the egg retrieval procedure in order for you to feel safe about the upcoming treatment. If necessary, we will give you tranquillizers and painkillers which should be taken 1 hour prior to egg retrieval. If your husband wishes to produce the semen sample to be used for fertilizing the eggs at home, please remember to ask for a tube to take with you.

Cancellation of treatment
In very few cases (approximately 2%) the growth of the follicles will be unsatisfactory, and treatment will have to be stopped in that particular month. The consequences are likely to be the change in FSH dosage in a new treatment cycle or the selection of a different type of hormone.

Ovulation induction
On the day when you are supposed to administer the injection which induces ovulation, you must not take the down regulation nor FSH (Gonal-f, Pergoveris, Menopur or Puregon)

Ovitrelle is a hormone which promotes the final maturation of the eggs prior to retrieval. The injection is extremely important and must be taken at a pre-determined timepoint approximately 34-36 hours prior to egg retrieval, ie late in the evening 36 hours before..

The timing of the injection is important, with half an hour’s deviation being acceptable. You can administer this and the FSH injection yourself.

If you forget to take Ovitrelle, it is not possible to retrieve any eggs at egg retrieval, so remember the injection

Side effects of the ovulation injection
Since Ovitrelle is a human chorionic gonadotropin hormone that may give the same symptoms as pregnancy, ie nausea. After the Ovitrelle injection has been taken, most women can feel that their ovaries have grown, and they will therefore feel a slight pain in the pelvis and extreme whitish discharge. This is quite normal and a result of the hormone stimulation and is therefore not a sign of premature ovulation

Egg retrieval
You and your husband must come to the clinic at the agreed date and time, and your husband is welcome to be present when we retrieve the eggs. Although this is carried out early in the morning and later in the morning, you should have eaten breakfast as this will reduce the risk of feeling uncomfortable due to hypoglycaemia (low blood glucose).

Most women takes a tranquillizer one hour prior to egg retrieval.

We often start by placing a bilateral, local anaesthesia in the wall of the vagina in order for it to have effect prior to the actual egg retrieval.

A needle is inserted into the cubital fossa (the region of the elbow joint), in which analgesics (pain killing medication) are given in the form of Haldid (Fentanyl), which is a rapid-acting, synthetic morphine drug with minimum side affects apart from drowsiness. You may also request for acupuncture as a supplement to the analgesic. This is done free of charge.

Most women are nervous and tense. How will things be done? Will I feel much pain? How many eggs are retrieved? Most women perceive the egg retrieval process as very undramatic and only feel slight pain similar to menstrual pain. During the process, we inform you about what will happen in order to make you feel comfortable.

The egg retrieval is an ultrasound-guided procedure carried out through the vagina (transvaginal ultrasound). A needle is passed through the top of the vagina directly into the follicles of the ovaries which are on the other side of the vaginal wall with only a few millimeters between. This facilitates the aspiration of the eggs. It is done bilaterally until the fluid of the follicles has been aspired and all eggs have been sucked out of the ovary. This normally takes approximately 10 minutes. It is possible for you to monitor the entire egg aspiration process on a video screen. The eggs are only 1/10 mm and lie inside the fluid-filled follicle, which is the reason why you cannot actually see them. What you see on the ultrasound scan is the fluid-filled follicle which is aspirated and flushed. The fluid of the follicle is sucked into a test tube and brought to the laboratory where lab personnel view the fluid under a microscope. They are able to determine if there are any eggs in the follicle fluid. Of course, we will tell you how many eggs we have retrieved. On average, 8-10 eggs are aspirated if the female is under 37-38 years. If the female is over 40 years, only half as many eggs are available. In very rare cases, it is not possible to retrieve any eggs (2%).

After egg retrieval, you should rest at the clinic in one of our relaxation rooms. Your husband will be requested to produce a semen sample in our “men’s room” if he has not already produced it at home prior to coming to the clinic (see below).

When you feel fine again and the sedative effect of the painkilling medication starts to wear off after approximately one hour, you can go home and take it easy the rest of the day. The medication you have been given may reduce your ability to react, and you should therefore not drive your car the rest of the day.

After egg retrieval, you will be informed about when to initiate treatment with Crinone gel which you would typically start on taking the day after egg retrieval. This gel should be applied in your vagina once daily in the evening after you have gone to bed for the next 15 days. The gel is a progesterone hormone supplement. Normally, this hormone is formed in the ovaries, but the production may be inadequate after treatment with the nasal spray. The purpose of the progesterone supplement is to make the uterine mucus membrane more susceptible to the fertilized egg(s). The gel may cause moderate side effects in the form of transient fluid retention in the body, vaginal cramps, dizziness, nausea and breast enlargement, but these symptoms are rare.

It is normal to experience slight bleeding and pain after the egg retrieval process. The pain will normally be relieved on the intake of Panodil (2 tablets x 2 daily).

In very rare instances, heavy pain, fever or vaginal bleeding may occur. You are always welcome to contact us between 9.15-12.00 and 12.30-14.30 on +45 76 24 50 20 and also at our emergency phone +45 31 15 15 05. If you need urgent help, you can call the emergency centre (+45 112, in Denmark).

Semen sample
After egg retrieval, your male partner will be asked to produce a semen sample to be used for fertilization of the eggs. We have a special “men’s room or semen room” dedicated for this purpose. Your male partner should refrain from ejaculation for 2 days prior to egg retrieval. As the semen, on the other hand, should not get too “old”, we recommend a maximum sexual abstinence period of 5 days. The recommendation of the two days is given to ensure that the semen is fresh and consequently optimal for fertilization of the eggs. If you have less than one hour’s transport to the clinic, it is alright for your partner to produce the sample at home in the beaker you have been given. Remember to hold the tube close to your body in order for it to maintain body temperature. When arriving at the clinic, hand in the beaker to the secretary or the lab.

If your husband has had high fever due to an influenza, laryngitis or similar illness three months prior to treatment, we would like to know, as this might induce reduces semen quality and in such cases it might be necessary to perform micro-insemination (see below).

Fertilization of the eggs.
The eggs are mixed with your partner’s washed sperm with 150,000-500,000 sperm cells to each egg. In doing so, we hope that the fastest and best sperm can fertilize the individual egg. If the sperm count is low (< 2 million after washing) or if in previous attempts, fertilization of the eggs has been reduced, we will suggest micro-insemination (Intra Cytoplasmic Sperm Injection – ICSI) in order to optimize the fertilization rate. The ICSI procedure involves injection of one sperm into each egg under a microscope.

If you have not already paid for this, there is an extra charge of DKK3,000.

This method is associated with no risk at all, and results in no increased congenital defect rates. A few baby boys may, however, inherit their father’s reduced sperm quality.

The day after, we can see how many eggs have been fertilized. If you are interested, we will call you in the morning between 8.30 and 9.00 and inform you of the status.

Within the next 24 hours, the fertilized egg will divide into two to six cells. If they develop satisfactorily, one or a maximum of two eggs are transferred two days after egg retrieval. Whether or not one or two eggs are transferred into the womb depends on their development, the number of previous treatments and the age of the female. The rest of the eggs are frozen if suitable for freezing. We can also cultivate the eggs for three days if your history indicates that it has been difficult to choose the right eggs after two days’ cultivation. If your eggs are retrieved on a Friday, the eggs will always be transferred on a Monday, ie after three days’ cultivation. Major studies have shown that there is no difference in the results involving two and three days’ cultivation.

How do we assess whether the eggs are suitable for transfer or not?
It is our experience that pregnancy is best achieved with eggs that have divided into four cells two days after egg retrieval and into eight cells three days after egg retrieval. Also, it is a good sign if the cells of the egg have the same size (ie the cells divide equally) and there is not too much so-called fragment inside the egg. Fragments are residue from cell division lying outside the cells, but within the outer shell of the egg. Below you can see examples of eggs of different quality: 

        4-celle-uden-fragment

     8-celle-uden-fragment

     4-celle-med-lidt-fragment

    2-celle-meget-fragment

 4-cell embryo without

fragment (day 2)

 8-cell embryo without
fragment (day 3)

 4-celle embryo with
moderate fragment

Poor quality embryo

with much fragmentation

 

One or two eggs?
When we have to decide how many embryos we should transfer to the uterus, we will always suggest that you follow the recommendations of the Danish Fertility Society:

Transfer of the fertilized embryo(s).
The embryo transfer is similar to a standard gynaecological exam. The fertilized embryo(s) are transferred to the uterus with a thin plastic catheter which is inserted through the cervix canal. The procedure is normally associated with no discomfort. It is an advantage to come to the clinic with a full bladder, ie you should urinate two hours prior to your visit and subsequently drink a large glass of water 1-2 hours before. The advantages of a full bladder is that it unfolds the often anteverted (“tipped up”) uterus to a more accommodating angle. Women with a posterior uterus therefore need not present with a full bladder.

After embryo transfer you should take it easy, but otherwise live completely as you usually do. As we know that an embryo will attach to the lining of the uterus approximately 4 days later, it is also appropriate for psychological reasons to create optimum conditions for this process by refraining from major physical exertion. In other words, this is not the time when you should start jogging, but if you are used to running several times a week, the body is used to this type of physical exertion, and it will therefore not have an adverse impact on your chances of becoming pregnant. The embryo/embryos are only 1/10 mm large and cannot fall out of the uterus.   

Since the day after egg retrieval described above, you have been using Crinone gel which is a progesterone supplement which improves the chances of the embryos developing and attaching. Crinone gel is applied to the vagina twice a day for the next 14 days unless otherwise agreed. Some women experience lumpy, grayish discharge during the use of Crinone. Surplus residue can be washed away in the morning shower. The gel can affect the lining of the uterus in such a manner that the menstrual period is missed although the woman is not pregnant. A missed menstruation is therefore not a guarantee of pregnancy. However, Crinone cannot give a false positive pregnancy test, so if the test is positive, the woman is pregnant. In case of positive pregnancy test, you should continue using Crinone until the ultrasound scanning in gestational week 8. If the pregnancy test is negative, you can discontinue the Crinone and await a bleeding. If you are in doubt of a positive pregnancy test, you should continue using Crinone and repeat the pregnancy test after two days.

Cancellation of embryo transfer
If the eggs have not been fertilized or do not develop satisfactorily (seen in approx. 8% of cases) and it is therefore not possible to continue with a transfer of the embryo, we will call you on the morning of the scheduled embryo transfer. We can agree on the next step of treatment or perhaps make an appointment for a new consultation and talk where we will discuss the current, cancelled embryo transfer and plan a new procedure.

Freezing of fertilized eggs.
If there is a surplus of suitable eggs from the embryo transfer, which is seen in almost half of the patients, such eggs will be frozen if you so wish. We will then give you a “Thawing authorisation” which must be signed by both parties prior to transfer of frozen eggs. According to Danish law, eggs can be frozen for a period of 5 years, following which they must be destroyed. It is your responsibility to remember the “expiry date” of the eggs. The frozen, fertilized eggs must only be used by you and you are not allowed to donate the eggs to other infertile couples. If you wish to donate eggs to others, the eggs must not be fertilized. If you wish to donate your eggs, you must inform us of this as early in the process as possible. Egg donation is nearly always anonymous and described in detail in the section “Egg donation”.

Pregnancy success rate.
The chance of a positive pregnancy test per completed treatment at IVF-SYD is dependent on the age of the woman, see our results here. Since our clinic opened in 2006, we have had some of the highest pregnancy rates every year. We are very grateful for this, and it is our dedicated goal to maintain these promising statistics. The advantages of choosing a clinic with good results is of course, that the chances of obtaining a positive result increases and the number of treatments are minimized.

You can read more about our treatment results in IVF-SYD’s annual reports on our website. The pregnancy success rates of all fertility clinics are published every year at the Danish Fertility Society’s annual meeting and their website (www.fertilitetsselskab.dk).

Pregnancy test
14-16 days after embryo transfer, you will be subjected to a pregnancy test. In connection with the embryo transfer, you will be given a pregnancy test kit in order for you to carry out your own urine pregnancy test. Please call IFV-SYD and tell us if the sample is positive. It is important that the pregnancy test is collected even though there is a slight bleeding. The fact is that bleeding may occur in spite of a normal pregnancy. Minor bleeding can, however, also be the sign of an ectopic pregnancy, and it is important that this diagnosis be made as early as possible. If you are not quite sure that the test is positive, you should repeat the test a few days later.

If the pregnancy test is positive, you will be given an appointment for a pregnancy scan three to four weeks later, at which time you will be seven – eight weeks pregnant.

Remember to continue taking GraVitamin.

Pregnancy scan at positive test
At the pregnancy scan, it will be possible to determine, whether or not the pregnancy is developing normally. 

You will be asked to contact your GP to have a pregnancy chart made, a double test taken and be referred to a nuchal translucency scan .

After completed pregnancy, we would like to be informed of the progress of the delivery and the child’s/children’s data and health condition. At the pregnancy scan you will be given a form to take with you home and complete and send us to after your child has been born. The Danish Medicine Agency requires that all pregnancies and child deliveries are reported. If you are so unfortunate that your pregnancy ends in a miscarriage, we would appreciate it if you would inform us of this as well.

In the case of a negative test
If the pregnancy test is negative, it is always possible to have a talk with one of our doctors. Every time embryos are transferred in women under the age of 40, the pregnancy success rate is around 40-50%. In women above the age of 40, the chance is reduced by 50%. Therefore, quite a few experience the disappointment of a negative outcome. Your chances of a positive test after each embryo transfer are equally as good if the transfer involves viable eggs. After a negative test, we go over all the elements of the treatment to assess if some of them need readjusting if you have another go at treatment. We hope of course, that you wish to try again, but we recommend that you wait until after your next period, ie one month’s interruption. You should know that menstrual cycles may be slightly longer after hormone therapy as it takes some time for the body to get back to normal again. If you have two or more frozen eggs we normally recommend that these eggs are used prior to new stimulation. In this way, there will be a break between treatments and if you become pregnant by using the frozen eggs, you avoid having to go through yet another IVF treatment.

Why did we not become pregnant?
We do not exactly know why pregnancy is not achieved when we transfer embryos to the uterus.

The explanations are many:

Hyperstimulation
Hyperstimulation of the ovaries is sometimes seen in particularly young females with many eggs and in females with polycystic ovaries (PCOs). We try to avoid this complication by taking into account the female’s age, the size of the ovaries and the number of eggs. Some patients, however, react very strongly to the hormone stimulation and produce many eggs.

If we discover too many follicles (more than 20-25), we suggest that you suspend the FSH injections for a short while, but continue using the nasal spray until we find that the hormone reaction has dropped to a normal level and it is possible to continue.

In some cases we might consider freezing all the retrieved and fertilized eggs, since a pregnancy may increase the risk of enhancing the symptoms of hyperstimulation. If there are less than 25 follicles, we will normally complete the treatment.

Even when there are less than 25 follicles, symptoms of hyperstimulation may emerge during the period after embryo transfer, given that that the ovaries grow and in some cases secrete fluid to the abdominal cavity.

Symptoms of hyperstimulation occur two to 14 days after the injection of Ovitrelle.

If your stomach feels very bloated, breathing is difficult because of the distended stomach and you feel nausea and/or vomit, this could be a sign of hyperstimulation, and it is therefore important that you call us at IVF-SYD as early in the day as possible, so that we can scan you on the same day.  

Treatment of hyperstimulation
Normally, conservative treatment with ample fluid intake is sufficient treatment and the condition will gradually subside. We recommend that you drink approximately 3 liters of fluid per day. The problem with hyperstimulation is that fluid containing potassium leaks from the ovaries, the arteries and the tissue into the abdominal cavity. Therefore, you should make sure that your food and drinks are rich on potassium. Potassium is present in apple and tomato juice as well as mineral water. Foods containing potassium are bread, potatoes, lean fish, spinach, bananas, boiled fruit and vegetables, and raisins.

 

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