Infertility and ivf

Infertility and IVF

The IVF Unit at Sophiahemmet

The IVF Unit was established in 1984. We can offer most types of treatment for infertility.
IVF (in vitrofertilization) constitutes a large part of our work.

Staff:
Physicians: Arthur Aanesen, MD, PhD
Claes Gottlieb, Associate Professor
___________________________________________________________________________ Visiting address: ISO 9001: Broschyr engelska | 2006-09-08 | 1.0 |LN | KH |
When is IVF applicable?
Damaged tubes.
Tubal infertility is a main indication for IVF. In many cases a previous tuboplasty
has been performed without positive result. IVF then remains as the best alternative.
Male infertility.
We have experienced that male infertility is becoming a substantial part of our indications for IVF. New
techniques such as microinjection and sperm aspiration has given us tools to help this group of patients.
Unexplained infertility.
IVF is one of several possible treatments in these cases.
Other indications.
There are a number of other diagnoses that are indications for IVF such as endometriosis, immunological
defects etc.
Prerequisites for treatment
A thorough hormonal and clinical investigation of the infertility should have been performed.
Our age limit is <43 years.
The treatment
Several treatment regimes exist but most patients are treated with hormonal stimulation aiming at a large
number of mature oocytes.
Down regulation: 7 days prior to menstruation down regulation of the pituitary is initiated with daily injections
(or sometimes nasal spray) of buserelin. This blocks the stimulation from the pituitary to the ovaries. The
duration of this treatment lasts for two to three weeks and after this period the hormonal stimulation can start.
Alternatively the hormonal stimulation starts at the beginning of the menstrual cycle without previous down
regulation. Instead the pituitary is blocked by adding another injection to the stimulation hormone after five
days.
Hormonal stimulation of the ovaries: Injections of gonadotrophin (FSH, a hormone from the pituitary) are
given daily. The down regulation with nasal spray is continued simultaneously. This treatment is often
completed after two weeks.
Monitoring of the stimulation: Vaginal ultrasound examinations of the ovaries and the uterine lining is done
regularly with a few days´ interval. In addition, blood samples are analyzed for estradiol rise. The results
determine when ovulation induction with an injection of hCG should be administered.
Oocyte retrieval: In the morning two days after the hCG injection the oocyte retrieval is performed. This is
done vaginally under ultrasound guidance. Local anaesthesia and sedation is given. The woman can leave the
hospital in the afternoon. On the same day a sperm sample is required. The sperms are prepared during the day
and the insemination (i.e. sperms are added to the oocytes) is performed in the afternoon. The eggs are then
cultivated for two days in incubators.
Microinjection (ICSI): In cases of a very low sperm count or if there is any other major abnormality in the
sperm analysis, microinjection of one sperm into the oocyte can be used. An oocyte obtained after retrieval is
fixed in a holding pipette under microscopic control. Using micromanipulators one single sperm is injected into
the cytoplasm of the oocyte. Cultivation is performed for two days as at conventional IVF. Images from
cultivation of embryos can be found at www.ivf-gruppen.se
PESA: If no spermatozoa are found in the seminal fluid but the production of spermatozoa in the testes works,
there is a possibility of getting sperm from the epididymis. This is a procedure which is performed under local
anesthesia and an ICSI procedure then follows.
Assisted hatching: In women over 40 years of age and in some other defined cases assisted hatching might
improve the results: The shell surrounding the dividing pre-embryo is some-times hard to get out of . The
hatching procedure can be facilitated by a weakening of the shell by laser treatment before embryo transfer.
Embryo transfer: After cultivation the oocytes have cleaved and are now called pre-embryos. Transferral to the
uterus is performed with a very thin flexible catheter from the vagina, through the cervical canal, into the
uterine cavity. After a short rest the woman can leave the hospital.
IVF in a natural cycle is an alternative to the conventional IVF described. This is recommended primarily for
women under the age of 35 with a regular menstrual cycle. The natural menstrual cycle is monitored with
hormonal determinations and ultrasound examinations and oocyte retrieval is accomplished from the single
follicle that matures naturally.
To avoid high estradiol levels during treatment and/or to avoid an excess of eggs, another alternative is to give
only a slight stimulation with clomiphene, 2 pills a day for five days.
Cryopreservation: Usually two embryos are transferred at embryo transfer. If there are spare embryos of good
quality they can be frozen in liquid nitrogen for later use (FER = Frozen embryo replacement). This is of
interest if the first IVF treatment failed or if the couple wishes to have another pregnancy after the delivery of
the child of a successful IVF treatment.
The Swedish law restricts IVF treatment to couples constituted by a man and a woman. Surrogacy, embryo
donation or IVF using gamete (egg or sperm) donation is not allowed.
Success rates
In 2008 655 IVF treatments were completed at Sophiahemmet: 42% of the embryo transfers
performed after hormonal stimulation gave rise to a pregnancy in the age group below 37 years.
Women below the age of forty had a pregnancy rate of 39%. 143 frosen/thawn embryo transfers in
2008 resulted in a 34% pregnancy rate for women below the age of forty.
Please contact us by phone or fax or write to us for further information.
IVF Unit at Sophiahemmet
Visiting address: Valhallavägen 91, Entrance A
Postal address: Box 5605, S-114 86 Stockholm, Sweden
Phone: +46 8 406 20 00 Fax: +46 8 10 16 21
e-ma

Costs in vitro fertilization

All amounts in SEK


Visits
Monitoring of treatment with ultrasound

Source: http://www.ivf-gruppen.se/wp-content/uploads/BroschyrEngelska.pdf