Get the answers you need

Many patients, understandably, have a lot of questions before attending a clinic appointment. We have collated some of the most frequent of these so that you can find out as much as you wish to before coming in to the clinic.

Initial Consultation
Why do I need to have an initial consultation before commencing treatment?

The initial consultation is a chat that we have before you begin treatment where we give you information about the course of the treatment and what you can do yourself to become pregnant. We talk about the type of treatment we recommend for you and what your thoughts are. If you would like to use donor semen, then we will discuss the ethical aspects of becoming pregnant in this way. You can use the consultation to ask all the questions you have and tell us about what you want in relation to the treatment.

Will the consultation take place at Vitanova?

We prefer to have consultations at Vitanova because we feel that meeting face to face helps improve communication. You will have the opportunity to see the clinic and to meet us in person. It is also possible to hold the initial consultation over Skype as this also allows us to see each other face to face.

Should my partner attend the initial consultation?

It is best if both you and your partner are together throughout the entire process. Emotionally, it is very important and you will both be informed about what happens during the course of treatment. Following the consultation, your partner will also be required to sign our treatment consent form. If your partner's semen is going to be used in the treatment, then we will ask for a semen sample so that we can form an impression about the semen quality.

What languages do the Vitanova staff speak?

All of the staff at Vitanova speak both Danish and English. Some of us also speak Swedish, German, French, Italian, Arabic and Croatian. We can't promise that you will always be able to meet with someone who speaks your language, but this isn't usually a problem.

insemination (IUI)
What is the Intra-Uterine Insemination (IUI) process?

The first step in IUI treatment is to have an Initial Consultation. At this point the doctor will have a 30 minute consultation where the doctor will go through your medical history and devise a personalised treatment plan. It is recommended that you undergo a tubal patency test in order to ensure that your fallopian tubes are clear and the sperm is able to reach the egg. You will then need a number of scans following the start of your period. These will be used to monitor the growth of the follicles and track ovulation. Once the time is right to perform the IUI, the sperm sample will be washed and prepared before the procedure. The IUI procedure involves introducing the sperm to the uterus through a thin catheter at the correct time of the cycle when the egg is being released.

Do you have donor sperm available for use in IUI?

Yes, we have a bank of donor sperm at the clinic. You can select donor sperm from this bank or arrange for sperm from an external bank to be transferred to the clinic. If you would like to use a known sperm donor, this can also be arranged.

ICSI
What is ICSI?

ICSI stands for intra-cytoplasmic sperm injection. This refers to when the sperm is directly injected into the egg, rather than the sperm and egg being put in a dish to spontaneously fertilise.

Who is ICSI suitable for?

ICSI is generally used for patients where there is a male infertility factor or fertilisation problems.

Do you do ICSI?

Yes, we perform PICSI (Physiological Intracytoplasmic Sperm Injection). This technology allows embryologists to select the most suitable sperm to inject into the egg. The sperm can be tested to see how well it binds to Hyaluronan (HA), which is a naturally occurring substance on the surface of the egg. HA can be coated onto a dish, and the embryology team will chose sperm that bind to it. It has been shown that these sperm are more likely to be mature, mobile and healthy.

IVF
What’s the first step to IVF?

The first step is for you to have any required blood tests or scans done at your local doctors, following those results you will need to have a consultation with us. You will have your appointment where our doctor, who will go through the results and your medical history and devise a personalized treatment plan for you based on these.

Do I have to get the scan on a particular day of my cycle?

No, you can get the scan on any day of the cycle, including during your period if you are comfortable with this - it does not make any difference from the scanning point of view.

Do I have to have the scan done again if I’ve had one elsewhere?

We request that every patient have a scan within 3 months before starting any treatment. It is at the doctor’s discretion whether they will accept a scan from another clinic.

Should I bring anything with me?

If you have medical notes, from previous treatment for example, you can send copies of these to us in advance to be added to your file. Otherwise you do not need to bring anything with you.

What is Natural IVF?

Natural IVF, also known as Natural Cycle IVF, is a form of IVF treatment which is significantly gentler on the body compared to conventional IVF. Natural IVF doesn’t use any stimulating drugs, and Natural Modified IVF uses just a short course of stimulating drugs. Natural cycle IVF works within a woman’s own natural cycle, rather than shutting down the cycle (downregulation) and re-starting it with high stimulation drugs. It aims to collect the one egg that has been naturally selected and matured by the body, and the fertilised egg/embryo is placed back into the lining of the womb. Natural IVF is, therefore, the closest that IVF treatment can get to natural fertilisation. This approach is based on a focus on quality rather than quantity. Natural IVF is most suitable for women with low ovarian reserve, low AMH or high FSH.

What is Mild IVF?

Mild IVF focusses on quality rather than quantity of eggs, is conducted within a woman's natural cycle and uses lower doses of stimulating drugs. Mild IVF uses a short 5-9 day course of stimulating drugs to achieve a mild response. Mild IVF is designed to be gentler on the body with fewer side effects. The short protocols with lower doses of drugs mean that the stress and duration of treatment and potential side effects are reduced.

Should I do Natural or Mild IVF?

This depends on your own set of circumstances, and the doctor will be able to tell you what’s most suitable in the Initial Scan and Consultation. At this appointment, the doctor will do an internal scan with a 3D scanner, which will look at your ovaries and ovarian reserve, the womb lining and the blood flow to these. They will then go through your medical history and devise a treatment plan based on your scan and medical history. Usually, older patients or those with a low ovarian reserve will be advised to go for Natural or Natural Modified IVF. Mild Stimulation IVF works well for women with a good ovarian reserve, and it has excellent success rates.

Do you have selection criteria?

We accept any women up to the age of 46. We do not have any cut-off for AMH levels, and we will try to achieve fertility treatment for a woman with their own eggs if it is possible. We have had patients with AMH levels under 1 have healthy babies with their own eggs.

What is the process?

The first step is to come in for an Initial Consultation. At this appointment the doctor will assess your situation and devise a personalised treatment plan. After this, they will talk you through your treatment, give you your medication and teach you how to take it and go through the consent forms with you.

How long does it take?

After the first scan, the treatment takes approximately 2 weeks.

Is there a waiting list?

No, there is no waiting list. There are usually Initial Consultations available within a week. Starting the treatment depends on your cycle, as it will begin after your period starts. This means we can usually start at the beginning of your next cycle.

What are the success rates?

Our success rates vary depending on the age of the patient and the type of treatment.

Can I improve my chance of success?

We offer a number of technologies that might improve your chances of conceiving successfully with IVF treatment. Please discuss with a consultant to check whether any of these might be beneficial to you. IVM: In-vitro maturation (IVM) is a pioneering technology that can be used in conjunction with Natural IVF to create more embryos. Natural IVF aims to collect one mature egg, but with IVM smaller immature follicles can also be collected and matured in the lab.

IVF with donor sperm
Who is this treatment suitable for?

IVF treatment with donor sperm is most suitable for couples with a male infertility factor, female same-sex couples and single women.

Do you have donor sperm?

We work with only recognised and licensed donor banks to provide the best quality sperm. They can give you information on their skin, eye and hair colour and educational background before helping to match you with a donor. We are happy to work with outside sperm banks if you would prefer. It is also possible to use a known donor.

What is the process of having treatment with donor sperm?

The first stage is to have an Initial Consultation. At this point the patient(s) can discuss which donor sperm is to be used and the nurse can go through our list of sperm donors with you. If you decide to purchase sperm from an external sperm bank this is perfectly fine; however you will have to arrange for the sperm to be couriered to the clinic. The treatment itself is exactly like our other types of IVF: the female patient will take a suitable combination of drugs for several days before having her eggs collected under sedation. These will then be fertilised with the donor sperm in the lab before being transferred to the woman’s womb a few days later. If you plan to use a known donor, he will need to go through a series of stages to assess his suitability. It is best to contact us for more details on using a known donor.

IVF with donor eggs
Do you offer treatment with donor eggs?

Yes, we offer treatment with eggs from UK donors, Spanish donors and known donors. We have our own donor bank to choose from. For people of European descent, we usually do not have a waiting list. We also liaise with a clinic in Spain, so if there are no suitable donors in our donor bank, we can find a donor from the Spanish clinic which has a large selection. If you would like treatment with donor eggs, the first step is to come into the clinic for an Initial Consultation and Scan.

What is the process of having treatment with donor eggs?

You will have an Initial Consultation, where the doctor will go through your medical history and devise a personalised treatment plan. The nurse will discuss your treatment with you and help to match you with a donor.

Are the donors anonymous?

Yes, in Denmark, patients have the option to choose an open donor or an anonymous donor which means that no identifying information about the donor is stored.

What are the success rates?

The success rates for treatment with donor eggs are very good; you can read more about success rates here.

Using sperm Donor
Can I choose the sperm donor myself?

Yes, you can choose the sperm donor yourself on the Danish sperm bank website. Once you have chosen a donor, simply purchase the donor sperm online and ask the sperm bank to send it to us. We recommend that you wait until you have had an initial consultation with us before purchasing any donor sperm.

Is it possible to see photos of the donor?

If you purchase donor sperm from the sperm banks yourself, then you can select a donor with an 'in-depth profile'. As a rule of thumb, you can usually see a baby photo of the donor. Some sperm banks allow you to see a photo of the donor as an adult.

Does Vitanova sell donor sperm?

Yes, but Vitanova does not work like a sperm bank. We buy all the donor sperm we use from Danish sperm banks. You cannot buy donor sperm with an 'in-depth profile' here at Vitanova.

What is the difference between open and non-contact donors?

If you buy donor semen from a non-contact (anonymous) donor, then neither you nor your child will ever have the opportunity to contact the donor or receive detailed information about him. If you buy semen from an open donor (with id release), then the child may contact the sperm bank after they turn 18 years of age and receive more detailed information about the donor. It is important that you speak with the sperm bank about this before you purchase donor semen.

Are donors tested for communicable diseases?

Yes, all donors are tested for communicable diseases, hiv and hepatitis before they can become approved by the sperm bank. In addition to the above, the donor is also tested for a number of hereditary diseases. You can read more about this on the sperm bank websites.

Are donors tested for hereditary diseases?

It is not possible to test a person for all hereditary diseases. That is why most sperm banks have chosen to test for the most common genetic disorders. The sperm bank websites indicate what tests a donor must undergo in order to be approved as a donor.

Am I guaranteed a perfectly healthy child if I use donor sperm?

No, unfortunately it is not possible to give such a guarantee. Neither when using donor semen, nor when using your partner's semen.

Can I meet the donor?

Unfortunately this is not possible.

Is it important to choose a donor who has the same blood type as me?

No, this has no bearing on the outcome of the process. If this is important to you, then you can contact the sperm banks and purchase donor semen with the blood type of your choice.

Egg donation
Do I get paid for donating my eggs?

You will receive compensation of up to DKK7,000 for each egg donation treatment cycle. This payment is to reasonably cover any financial losses you might encounter in connection with your donation.

Will donating my eggs affect my fertility?

It's very unlikely that donating your eggs will have any negative effects on your fertility.

How many times will I need to visit the clinic?

You'll need to come to the clinic between 6-10 times.

Does donating eggs hurt?

Taking medication may produce a little discomfort but the egg collection will not hurt.

Can a child born as a result of my donation find out who I am?

When you become an egg donor you will be asked for certain details. This information will initially be used by the clinic to assess your suitability as an egg donor. When you go on to become an egg donor that information will then be passed on. Your information will always be kept confidential and stored in line with Data Protection legislation.

How are my eggs collected?

This procedure is performed in theatre under sedation and takes around 45 minutes.

Blood Tests
Which blood tests are compulsory prior to IUI/IVF treatment?

HIV 1 and 2, HbsAg, anti HBc, anti HCV and in some cases HTLV and MRSA (although this is not a blood test).

Do you recommend taking other tests?

In addition to the compulsory blood tests for HIV and hepatitis, we also recommend: Chlamydia, rubella and the cervical screening test (smear). We also recommend AMH, FSH, TSH and TPR, which are all hormone tests.

Are hormone tests compulsory?

Hormone tests are not compulsory, but we recommend that you take hormone tests so that we can give you better advice as to which treatment type is best for you.

What are HSU/HSG tests?

Hystero-Sonografic Examination (HSU) and Hysterosalpingography (HSG) tests indicate whether or not your fallopian tubes are open and thus whether there is chance of pregnancy occurring. If the fallopian tubes are closed, then you cannot become pregnant through intercourse or IUI, only IVF. A HSU test is performed using a saline solution and an ultrasound scan. A HSG test is performed using a contrast fluid and an X-ray.

What is AMH?

AMH (Anti-Müllerian Hormone) is a blood test that indicates the size of your egg reserve. A low AMH indicates a low egg reserve and thus a lower chance of pregnancy.

What is FSH?

FSH (Follicle Stimulating Hormone) is a hormone that is decisive for whether follicles will develop in the ovaries. A high FSH is a sign that your hormones are unbalanced. We can correct this by stimulating them with medication hormones. This blood test must be taken between days three and five of your menstrual cycle.

Why do I need to take thyroid stimulating hormone (TSH)?

Studies of fertility patients have indicated that a low TSH hormone level (metabolic hormone) leads to a lower chance of pregnancy.

What is AFC?

Antral Follicle Count, or AFC, is the number of unripe follicles in the ovaries. The number of follicles is counted using an ultrasound scan which must be taken at the start of your menstrual cycle. Together with the AMH value, the antral follicles indicate whether or not you are about to reach menopause.

IUI vs. IVF
What's the difference between IUI and IVF?

IUI is an intrauterine (inside the uterus) insemination. This is done by inserting a thin catheter through the vagina and into the uterus via the cervix. The semen (either donor semen or your partner's semen) is injected through the catheter into the uterus. This allows us to help the sperm cells find their way to the egg inside the uterus, and hopefully the egg will become fertilised. IVF stands for In-Vitro Fertilisation – fertilisation outside of the body; namely in the laboratory. We use hormones to stimulate the ovaries, so that more eggs are formed than in a normal menstrual cycle. The eggs are removed from the ovaries and fertilised in the laboratory, either using donor sperm or your partner's sperm. The fertilised eggs (embryos) are returned to the uterus, where they adhere to the uterus and result in pregnancy.

How do we decide which type of treatment is best?

Our treatment team will evaluate your options and advise you on what type of treatment is best. There are a number of parameters that are significant to our evaluation, including your age, blood test results and scan results, the quality of your partner's sperm, your fertility history and the type of treatment you would prefer to undergo.

Can I begin with IVF, without trying IUI first?

It is not necessary to undergo a course of IUI before undergoing IVF. We will give you advice on what type of treatment is best based on a number of different parameters. As IUI is a less costly and less invasive treatment than IVF, some women prefer trying IUI before then proceeding with IVF. We will be happy to follow your wishes provided that they make sense in relation to the various parameters in place, such as your age and hormone test results. We do not want you to undergo multiple IUI attempts if the likelihood of a pregnancy occurring is minimal.

Can i switch between IUI and IVF during a single course of treatment?

Yes, this is possible, and there are many different reasons why both are a good idea. For example, if you undergo hormone stimulation in preparation for IVF treatment but ultimately do not form more than 1–2 eggs, then we might recommend IUI for this cycle instead. This is always something we will discuss with you, and you will ultimately be the one to make the final decision.

When is IVF preferred over IUI?

In some cases we recommend starting with IVF treatments directly. This may be the case if: • One or both fallopian tubes are closed • The woman has been sterilised • The woman has had pregnancies outside the uterus • The woman has already undergone several IUI attempts without these resulting in pregnancy • The woman has a low AMH, but we still consider that there is a potential for stimulation • The partner's sperm is of low quality

When is IVF not advisable?

IVF is not advisable during a hormone stimulated cycle if: • The woman has a very low AMH • The woman has attempted IVF multiple times during a hormone stimulated cycle without follicle formation In these cases, we either recommend IVF in a natural or naturally modified cycle, or IUI.

Why is IVF more expensive than IUI?

The laboratory techniques used in IVF are much more advanced and also more expensive than those we use for IUI. IVF requires specialised and certified staff who can advise you about hormone stimulation and who are able to treat your eggs correctly in the laboratory. IVF also requires more advice and planning and this means that our gynaecologists need to be involved as well.

Hormone Stimulation
What does hormone stimulation mean?

By using medication that resembles a woman's hormones, we can stimulate the ovaries to produce more than one egg. In women who seldom produce follicles, these medication hormones can reinforce the women's own.

Who needs hormone stimulation?

We use hormone stimulation in women whose hormone test results indicate that their own hormones are not working optimally. We therefore support the woman's own hormones by adding some medically. Hormone stimulation is also usually required in women with polycystic ovarian syndrome (PCOS). If a woman is going to undergo IVF, then we use hormone stimulation to increase the number of eggs that are formed to around 6–8 eggs. This is to get the maximum benefit from the IVF treatment, which is relatively costly and also a major procedure.

How can I ensure that ovulation occurs?

We can ensure that ovulation occurs at the right point in time by injecting a hormone that promotes ovulation.

Can I administer the ovulation injection myself?

Yes, you can, and this must typically be done late in the evening. Injecting yourself is easy and we will jointly agree a time for you to do this.

Is hormone stimulation dangerous?

Hormone stimulation is not generally a dangerous process. We use very mild hormone preparations and there are not usually any side effects. You will only need to take the medication for a relatively limited period of time, so it will not have any effect on the body.

Progesterone following IUI?

There are no studies showing that progesterone has a beneficial effect following IUI in a natural cycle. However, we do recommend the use of progesterone following IUI in a hormone stimulated cycle.

Should I begin taking folic acid even before I become pregnant?

In Denmark, this is recommended. For the best effect it is advisable to start three months prior to pregnancy. It is not dangerous to continue taking folic acid even if it takes some time before pregnancy occurs.

Do I need to take vitamin D?

Some studies show that Scandinavians often have lower levels of vitamin D as a result of our long and dark winters. If this is the case for you then we recommend taking supplements but otherwise it is not necessary.

Price
Why can’t you get an exact online quote for my treatment?

Each patient is different and so is their treatment. At Vitanova, we tailor treatment to you in every area, from number of bloods tests, level of medication and frequency of scans. This personal approach means you only get the treatment we believe you need to give you the best chance.

Are there extra charges I need to know about?

We are always transparent and honest about pricing at every stage of your treatment journey. At your initial consultation, we give a detailed price estimate for the treatment we recommend. Depending on how your treatment progresses, there may be a need to review protocols based on your circumstances and in order to maintain the optimal chance for success there may need to be additional medication or scans. Any modification to your journey will be discussed in detail before anything is actioned. You will be fully aware of any potential costs.

Can I upgrade from 1 to 3 cycles?

In special circumstances, you can, but this will depend on your situation and recommendation from the Doctor. Moving treatment types is unusual as we focus all our efforts to make sure you get the very best diagnosis and treatment journey from the start. If agreed, patients can upgrade from 1 to 3 cycles or from 3 to 6 cycles.

How do I find out exactly what my required additional costs will be?

All of our patients have individual treatment plans drawn up after an Initial Consultation. This means that the exact amount for each patient will vary depending on their treatment and circumstances. We have split these out in more detail below, but for an exact breakdown, you will need to have an Initial Consultation. Additional costs could include: • Medication (varies depending on your individual requirement) • Blood tests (additional tests may be required throughout your treatment) • Sedation (required for each egg collection)

Male infertility
What is male fertility problems?

Male infertility is becoming an increasing problem in the developed world. For couples with infertility problems, male infertility is a contributing factor in up to 50% of cases. It is the sole cause in about 30% of cases. Infertility in men can be caused by varying problems including general lifestyle issues, disorders of male (reproductive) organs and genetic disorders. When it comes to sperm production, men’s testes are like factories. They are then stored in tightly coiled tube called epididymis, which lies on the side of the testis. Sperm are ejaculated in the semen which comes from prostate and seminal vesicles. Testes produce new sperm every 2 to 3 months. This means that a man’s lifestyle in the preceding months has an impact on the quality of the sperm sample. The good news is that it is widely accepted that men can improve the quality of their sperm by improving general health. Before recommending more invasive treatment, it is always important to try to optimise health to achieve the best sperm quality.

What is normal parameters?

For sperm to be considered as healthy it must have a count of 15 million per millilitre of semen, have a progressive motility rate of 32% (speed of movement) and a morphology (shape of sperm) rate of 4%. Note, this means that a man can have up to 96% abnormal forms, but still have a ‘normal’ sperm sample, as long as the other parameters are met.

Lifestyle factors

The common lifestyle choices that affect the quality of sperm are: Obesity Smoking Excessive alcohol consumption Recreational drugs Increased scrotal temperature High stress levels By cutting out unhealthy aspects of lifestyle, it is possible to improve male fertility and the chances of conception.

Specific problems

There are specific problems that can lead to male infertility. These include issues such as undescended testis, testicular tumours, varicoceles (prominent veins), blockage of the ejaculatory ducts, sexually transmitted diseases, chemotherapy for cancer, some medications and chromosome abnormalities such as Klinefelter syndrome. One of the most severe forms of male infertility results in azoospermia where no sperm appear in the seminal fluid. This is of two types: obstructive and non-obstructive. In the former, there is obstruction to the passage of sperm due to congenital, surgical (vasectomy) or previous infection. In the second type sperm production in the testis is impaired or damaged. This condition may be amenable to aspiration of sperm from the testis (testicular sperm aspiration-TESA) or extracting the sperm from the testis (testicular sperm extraction-TESE). In men with obstructive azoospermia it is often possible to aspirate the sperm from the epididymis (percutaneous epididymal sperm aspiration - PESA) with a needle.

Semen Production

Some male infertility is caused by problems with semen production. Azoospermia is classed as a man having undetectable levels of sperm in his semen; it occurs in 1% of the male population. Other sperm problems include: abnormal sperm mobility (making it harder for the sperm to swim to the egg) and sperm morphology (meaning that sperm are shaped abnormally and cannot fertilise the egg).

Testicular problems

There are also testicular problems which can lead to male infertility. For example, some men have undescended testicles, or testicles which have been affected by surgery, trauma, cancer or congenital defects. Sometimes the small tubes within the testicles are blocked so that the sperm do not make it into the ejaculate.

Hormonal problems

If there is a hormone imbalance or levels of testosterone are low, this can affect male fertility. Hormonal imbalances have a variety of causes such as drugs/medications, congenital disorders or tumours.

Ejaculation problems

Some men suffer from ejaculation problems, such as premature ejaculation (when ejaculation occurs too quickly) and retrograde ejaculation (when semen is ejaculated into the bladder).