Frederiksberg Fertilitet

    Treatments

IVF, ICSI, blastocyst, embryo, spermdonor, insemination

INSEMINATION & HSG

Tubal Patency Test / HyCoSy (HSG) 


HyCoSy stands for Hystero Contrast Sonography. This is an examination of the patency of the fallopian tubes using ultrasound scanning.


It is a prerequisite for achieving pregnancy naturally, as well as with insemination treatment, that there is passage through at least one of the fallopian tubes. The tubes may be blocked as a result of pelvic inflammatory disease or previous surgeries in the lower abdomen.
The examination is performed prior to starting insemination treatment.
The test is carried out after menstruation has ended and before expected ovulation, typically between cycle days 5 and 12.


Before the examination, a negative chlamydia swab from the cervix is required. This test can be done by your own doctor, but it can also be performed here in connection with the procedure.



How is the examination performed?

A small plastic catheter is inserted through the cervix into the uterine cavity. A few milliliters of saline are first injected into the uterus to ensure there are no polyps (small benign mucosal folds) or fibroids (benign muscle tumors) that need to be treated before starting treatment. Next, either a local anesthetic fluid or a specially prepared foam is injected into the uterine cavity. This creates a slight "overpressure" in the uterus, and the fluid will slowly pass through the fallopian tubes into the abdominal cavity, where it collects in a small pocket behind the uterus. Using simultaneous ultrasound scanning, the passage of the fluid through the fallopian tubes can be observed.



Intrauterine Insemination (IUI)
Insemination is a treatment method where sperm is placed directly into the uterine cavity. The treatment can be performed either in the woman’s natural cycle or in a hormone-stimulated cycle. Insemination can be done with donor sperm (for single women or lesbian couples) or with the partner’s sperm (for heterosexual couples).


If insemination is performed in the natural cycle, an ultrasound scan is done in the days leading up to the expected ovulation to monitor the size of the leading follicle. When the leading follicle reaches a certain size, ovulation is induced with a trigger shot, and insemination is performed approximately 36 hours later.


If insemination is performed in a stimulated cycle, an initial scan is done on day 2 or 3 of the menstrual period to check that the uterine lining is thin and that there are no large follicles or cysts on the ovaries. If everything looks good, instructions are given to start hormone treatment that evening, and a follow-up appointment is scheduled about a week later. Hormone treatment can be administered as tablets or injections (the choice depends on an individual assessment in consultation with the doctor to determine which type of treatment is best suited for each patient). The purpose of the hormone treatment is to mature 1-3 follicles on the ovaries. If the woman does not have a cycle, the goal is initially to mature one follicle; if she does have a cycle, the aim is for two mature follicles initially. When the follicles reach a certain size, ovulation is induced with a trigger shot, and insemination is performed approximately 36 hours later.


If donor sperm is used, the patient is responsible for ordering and purchasing donor sperm from an approved sperm bank. One straw is used per insemination, and it is recommended to buy MOT 20 straws for insemination treatment.


If the partner’s sperm is used, the man must provide a semen sample on the morning of the insemination (see info on diagnostic semen analysis).


On the day of insemination, the patient arrives at the clinic with a full bladder. The insemination itself is performed on a gynecological examination table, where a speculum (the instrument used during a gynecological exam) is inserted. A thin and soft catheter is then introduced into the uterine cavity, and the sperm is injected directly into the top of the uterine cavity.


A pregnancy test is taken 14 days after the insemination. If the test is positive, an appointment is booked for a pregnancy scan three weeks later. If the test is negative, a new treatment can be started at the beginning of the next period, if desired.

IVF/ICSI

SHORT PROTOCOL


On your first day of menstruation, you can sign up for treatment. You will then be scheduled for an ultrasound scan. During the scan, we check that you are ready to start by ensuring that your uterine lining is thin and that there are no large follicles or cysts on your ovaries. If everything looks good, you will start hormone injections that same evening (we will show you how this is done).


From about the 6th FSH day in the morning, you will begin treatment with an additional injection (antagonist) to ensure that you do not ovulate prematurely. From day 6, you will therefore be treated with two different medications and will need to inject yourself both morning and evening. You will be seen again for another scan 8-10 days later. At this scan, we assess the size of your follicles and decide whether another scan is needed or if we can schedule the egg retrieval.



LONG PROTOCOL

As an alternative to the short protocol, in some cases, a long protocol may be indicated, where you are pre-treated for 2 weeks with either injections or nasal spray before the actual ovarian stimulation begins. We call this downregulation. The pituitary gland is emptied of hormones, so we can better control the stimulation afterward.


You sign up for treatment on the first day of your period and will typically be seen between cycle day 18 and 25. To start downregulation, you must have ovulated. Downregulation can be associated with side effects for some, typically headaches, mood swings, and sleep disturbances.


You should have a period during downregulation. The period is often different than usual, coming earlier or later—this is completely normal. If you have not had a period after two weeks, contact the clinic.
After at least 2 weeks of downregulation, you begin ovarian stimulation, which then follows the same process as described in the short protocol.



Ovulation trigger injection

You will be told when to take this. The ovulation trigger is always taken in the evening, typically 36 hours before the egg retrieval. It ensures that the eggs mature fully in the follicles, and the eggs will be retrieved before you ovulate naturally.


The ovulation trigger is typically taken 36 hours before the planned egg retrieval.



EGG RETRIEVAL

You have the option of having a venflon (a small plastic cannula in the vein) inserted, through which you can receive fast-acting and effective pain relief.
The doctor performs an ultrasound and applies local anesthesia to the top of the vagina, after which the ovaries are accessed via the vagina to empty the follicles. Usually, only one puncture is needed on each side. All mature follicles are emptied.


You cannot expect to get eggs from all follicles. The embryologist finds the eggs using a microscope in the laboratory. After the egg retrieval, you will be informed of how many eggs were collected. The procedure takes 5–15 minutes, depending on the number of eggs and how easily they are retrieved.


Your partner or companion can sit right next to you during the egg retrieval. You may feel a bit drowsy from the pain medication, but you will be awake throughout the procedure.


TOTAL FREEZE

If more than 15 mature follicles have been emptied, it is safest for you if we plan a total freeze. With a total freeze, all mature follicles are emptied, and the eggs are fertilized as agreed in the laboratory. They are cultured to the blastocyst stage and frozen on day 5 or 6 after egg retrieval. This approach is chosen to reduce the risk of overstimulation. By avoiding embryo transfer in the same cycle, the risk of overstimulation is significantly reduced. We will plan a suitable freezing treatment at a later time.


AFTER EEG RETRIEVAL 

You will be informed about aftercare. After about 20 minutes of rest, you can go home. The woman should not drive herself if she has received intravenous pain medication and should preferably be with another adult for the next 6 hours.


IN THE LABORATORY 

The eggs in the laboratory can be fertilized either by IVF (In Vitro Fertilization) or ICSI (Intracytoplasmic Sperm Injection).


IVF (In Vitro Fertilisation)

With IVF, the eggs are placed in a petri dish and the best sperm are added, after which the sperm swim in and fertilize the eggs themselves. The fertilization process and development are monitored for the next 5–6 days.


ICSI (IntraCytoplasmic Sperm Injection)

With ICSI, the embryologist injects a single sperm directly into a mature egg using a very fine needle. We recommend ICSI if the man's sperm quality is significantly reduced, for example, if there are fewer than 5 million sperm after sperm preparation or if sperm motility is poor.
If fertilization does not occur with regular IVF, even if the semen sample appears normal, ICSI may be a good option next time.


EMBRYO CULTURE

The fertilized eggs are cultured for 5–6 days, during which we follow the development of each embryo to the blastocyst stage. The best blastocysts are then selected for transfer and freezing. You will be informed about the quality of the blastocysts on the morning of the planned transfer day. You can also contact the clinic for updates on development.


EMBRYO TRANSFER

Embryo transfer is performed during a gynecological examination and an abdominal scan. A soft, thin catheter is inserted into the uterine cavity so that the blastocyst can be placed in the optimal spot. You should arrive with a full bladder, and you can go home immediately after the transfer, but you also have the option to relax in the recovery room.


FREEZING

If there are several good blastocysts on day 5 or 6 after egg retrieval, we offer freezing. Frozen blastocysts can be stored and used later. The frozen blastocysts can be stored until the woman turns 46 years old.


PREGNANCY TEST 

11 days after egg retrieval, a pregnancy test is taken. If it is positive, a blood test will be ordered. We will review the result with you and guide you on the next steps.


SPERM DONATION 

There can be various reasons why donor sperm is needed. For most people, choosing the ‘right’ sperm donor is a significant decision. We are happy to help guide you in making the best choice for a future sperm donor, both based on factual information and more personal preferences.


Donor sperm can either be purchased from sperm banks or come from a known sperm donor.


Donor sperm from sperm banks:

Here, the donor has been screened regarding his own health, family history, and has tested negative for HIV and hepatitis at the time of donation – and on this basis has been approved to donate sperm.
You can choose between non-ID release and ID release sperm donation.


Non-ID release sperm donationis a non-anonymous sperm donation. The sperm donor himself decides what information can be obtained about him beyond basic profile information (height, weight, hair color, eye color, and skin color). It is not possible to obtain the donor’s identity at any time, nor will it be possible for any child to obtain the donor’s identity. Likewise, the donor will never be able to obtain information about any children conceived from his sperm.


ID release (open sperm donation)means that the donor’s identity is not known to you at the time of donation, but the donor has agreed with the sperm bank that, at a later point, it will be possible for any child to obtain the donor’s identity or at least certain additional information. Most often, this means that the child will be able to obtain the donor’s identity when they turn 18. The donor will never be recognized as the father of the child or receive information about any children conceived from his sperm.


Extended profile:Both types of sperm donation can have an extended profile, where you can get more information about the donor than what is included in the basic profile. The donor himself decides what additional information can be provided – for example, information about the donor’s occupation, hobbies, education, voice sample, baby photos, or similar.



Types of sperm straws:


IUI straws:
IUI straws contain washed sperm that has been prepared in a laboratory. The natural seminal fluids have been removed, and a cryopreservative has been added. IUI straws are ready for use in insemination treatment, where the sperm is inseminated directly into the uterus. IUI straws can also be used for IVF and ICSI treatments.


The quality of sperm straws is defined by MOT. MOT stands for ‘Motile Total’. This indicates how many sperm cells are moving forward. MOT is measured in millions per ml (mill/ml), so MOT20+ means that in one ml there are at least 20 million motile sperm cells.


We recommend buying MOT 20 straws – one straw is used per treatment. In some cases, it may be necessary to buy a lower quality – in such cases, we recommend a minimum of MOT 10 for insemination and a minimum of MOT 5 for IVF/ICSI.



ICI-straws:

ICI straws are unwashed/unprepared sperm. ICI straws contain the natural fluids present in semen. ICI straws are not ready for use in insemination treatment – they must be processed before use in insemination, IVF, or ICSI treatment. ICI straws should generally be of higher quality than IUI straws, and the quality can vary after processing.



General information about donor sperm:

Although sperm donors are thoroughly questioned about the risk of possible hereditary diseases, we are obliged to inform you that there is a risk of passing on hereditary diseases when using donor sperm.


If, contrary to expectations, the child should have any health issues at birth or in the first years of life, it is important that you contact the clinic so it can be assessed whether the specific sperm donor should continue to be used. This is to determine if the condition could be hereditary.


The same applies if you are informed that there may be a risk of transmission of infectious diseases. Even though the donor has tested negative for infectious diseases such as HIV and hepatitis, the risk is never zero, and not everything can be tested for.


We must also point out that information about hereditary diseases in the donor may arise at a later time, which could result in the donor being blocked and no longer allowed to be used. Blocking of a donor can occur many years after donation, as some hereditary diseases only appear later in the donor’s life. If your treatment with donor sperm results in the birth of a child, and information arises about the donor that, according to the current rules of the Danish Health Authority, leads to the donor being blocked, you will be notified until the child is under the age of 18.


When the child turns 18, they may, in principle, be contacted directly.



Known sperm donation:

Known sperm donation means that both the sperm donor and the recipient—who may be a single woman, a lesbian couple, or a heterosexual couple—know each other beforehand. At Frederiksberg Fertility, we offer known sperm donation to anyone who needs this type of fertility treatment.


With known sperm donation, different legal agreements can be arranged depending on whether the recipient is single or part of a couple. For single women, the sperm donor will often have legal obligations towards the child. For couples, a legal document (form 9) can be drawn up, in which the sperm donor does not have legal obligations towards the future child. It is important to emphasize that known sperm donation is always voluntary and that no financial compensation is exchanged between the parties.


PARTNER DONATION/ROPA

ROPA (Reception of Oocytes from the Partner) – Partner donation


ROPA, also known as partner donation, became legal in Denmark from January 1, 2025. This fertility treatment is aimed at lesbian couples, allowing two women in a relationship to share the process of having children. It enables one woman to be the genetic mother of the child, while the other woman has the opportunity to carry the pregnancy and give birth. One woman donates eggs by undergoing hormonal stimulation and egg retrieval (see under IVF/ICSI). The retrieved eggs are fertilized with donor sperm or sperm from a known donor, and the fertilized egg is then transferred to the other woman, who carries the child.


The treatment allows both women to participate actively in the pregnancy and parenthood, with one contributing the egg and the other carrying the pregnancy. ROPA is an option for lesbian couples who wish to become parents together and participate equally in the process.


It is important to emphasize that the woman who carries and gives birth to the child becomes the child’s legal mother. The donating partner can become the child’s co-mother if a ‘Form 8’ is submitted to the Danish Family Court (Familieretshuset).

KNOWN EGGDONATION

If it is not possible to achieve pregnancy with your own eggs, it is possible to receive egg donation. In our clinic, we offer ROPA and known egg donation. Known egg donation is the type of egg donation where you know your egg donor. The known egg donor undergoes the same screening as other egg donors, and you will be informed if there are any remarks from the screening so you can decide whether you still wish to receive eggs from your known donor. The egg donor will undergo hormone stimulation corresponding to a short protocol  and will have an egg retrieval. As soon as the eggs are in the laboratory, the eggs become your property, and they will be cultured to the blastocyst stage and frozen for you for a future embryo transfer.


SOCIAL FREEZING

Social freezing is a treatment used when someone wishes to postpone pregnancy and wants the option to have their eggs fertilized at a later time. In this process, unfertilized eggs are frozen so they can be used and fertilized in the future. The treatment can be based on either medical or social reasons.


The frozen eggs are stored at the clinic until they are used or until the woman turns 46 years old, in accordance with Danish law.The process of freezing unfertilized eggs is the same as for fertilized eggs and involves hormone treatment and egg retrieval.Social freezing is offered to all women under the age of 46, but research shows that the chances of pregnancy are highest when eggs are frozen before the woman turns 35, as egg quality declines with age.


EGG FREEZING TREATMENTS 

You may be offered a freezing treatment if you have previously undergone hormone stimulation and egg retrieval and therefore have blastocysts in storage, or if you are undergoing treatment with a known egg donor or partner donation (ROPA).

It is a legal requirement that before each freezing treatment, you sign a document granting permission to thaw a blastocyst.


Natural Cycle If you have a regular cycle, the freezing treatment is planned in a natural cycle, where you will be scanned in the days leading up to the expected ovulation to monitor the size of the leading follicle. When the leading follicle reaches a certain size, ovulation will be induced with a trigger shot, and a blastocyst will be scheduled for transfer one week after the trigger.
You can take a pregnancy test 11 days after the embryo transfer. If the test is positive, an appointment will be booked for a pregnancy scan three weeks later. If the test is negative, you may start a new treatment at the beginning of your next period if you wish.



Modified Natural Cycle 

If you do not have a regular cycle, a so-called modified natural cycle can be used, where typically 1–3 follicles are matured. You will come for a scan on day 2 or 3 of your period to ensure the uterine lining is thin and there are no large follicles or cysts on the ovaries. If everything looks fine, you will be instructed to start hormone injections that evening, and a follow-up scan will be scheduled about a week later. When the leading follicle reaches a certain size, ovulation will be induced with a trigger shot, and a blastocyst will be scheduled for transfer one week after the trigger.


You can take a pregnancy test 11 days after the embryo transfer. If the test is positive, an appointment will be booked for a pregnancy scan three weeks later. If the test is negative, you may start a new treatment at the beginning of your next period if you wish.

man ikke har en regelmæssig cyklus kan man efterligne en naturlig cyklus i en såkaldt modificeret naturlig cyklus, hvor man typisk modner 1-3 ægblærer. Her møder man til scanning på 2.-3. blødningsdag, hvor man sikrer sig, at slimhinden er smal og at der ikke er større ægblærer eller cyster på æggestokkene. Såfremt alt ser fint ud, instrueres man i opstart af hormoner (indsprøjtninger) samme aften og der aftales scanningskontrol ca en uge senere. Når den ledende ægblære har en vis størrelse, vil man inducere en ægløsning med en ægløsningssprøjte og planlægge oplægning af en blastocyst en uge efter man har taget ægløsningssprøjten.



Substituted Cycle 

If you have entered menopause or have not become pregnant in a natural or modified natural cycle, treatment can be done in a so-called substituted cycle. Here, the uterine lining is stimulated with estradiol (tablets), and the first scan is performed after 10–12 days of treatment. If the lining appears satisfactory in appearance and thickness, you will be instructed to start progesterone supplementation, which is taken together with estradiol tablets, and a blastocyst will be scheduled for transfer six days later. You should continue taking estradiol and progesterone after the embryo transfer.


You can take a pregnancy test 11 days after the embryo transfer. If the test is positive, an appointment will be booked for a pregnancy scan three weeks later. If the test is negative, you may start a new treatment at the beginning of your next period if you wish.


PREGNANCY SCAN/NIPT

Early Pregnancy Scan – Regardless of How You Conceived
An early pregnancy scan can provide reassurance in the early stages of pregnancy.


We know that early pregnancy can be emotionally challenging, and the time from your first positive test until the nuchal translucency scan can feel like an eternity. We offer early pregnancy scans when you are 6–10 weeks along. During this scan, we can see early milestones such as the gestational sac, yolk sac, embryo, and heartbeat. The scan is performed transvaginally to obtain the best possible image.


We can also check for twins, measure the length of the embryo, and thus estimate an approximate due date.
At this stage, we cannot screen for malformations or determine the sex of the baby. Even if you have undergone fertility treatment and had a high-quality blastocyst transferred, there is still a risk of miscarriage, just as with a naturally conceived pregnancy.


NIPT (Non-Invasiv Prenatal Test)

If you need further reassurance about the health of your baby, early pregnancy scans can be supplemented with the so-called NIPT test. This is a blood test taken from the mother, which can very accurately determine the likelihood of the most common and serious chromosomal abnormalities in the baby, as small fragments of fetal DNA are present in the mother’s blood.


However, it is not possible to test for everything—NIPT provides greater, but not complete, certainty that the baby is healthy. This test does not assess the risk of mosaicism, partial trisomies, or translocations.


We always recommend that you continue to follow the standard scan offers provided to all pregnant women in the public healthcare system. There is no risk of miscarriage with this test, which can be performed from gestational week 10+0 up to week 24+0. We will always perform a scan before taking the NIPT test.


Humans have 23 pairs of chromosomes, which are strands of DNA and proteins carrying genetic information. A trisomy is a chromosomal condition that occurs when there are three copies of a particular chromosome instead of the usual two. NIPT tests for the following trisomies:

  • Trisomy 21 (Down syndrome):One of the most common causes of severe intellectual disability. Often associated with malformations, especially of the heart, and problems with vision and hearing. The risk of Down syndrome increases with maternal age.

  • Trisomy 18:Associated with a high rate of miscarriage. Infants born with trisomy 18 may have various medical conditions and a shortened lifespan.

  • Trisomy 13:Also associated with a high rate of miscarriage. Infants born with trisomy 13 usually have severe congenital heart defects and other medical conditions. 


Additionally, NIPT can test for sex chromosomes (boy/girl) and abnormalities in the sex chromosomes (Turner syndrome, Klinefelter syndrome, triple X, and XYY karyotype).


Results are available after 10 working days.
The results will be discussed with you, and an abnormal NIPT result should be followed up with a chorionic villus sampling (CVS) or amniocentesis, as false positive results can occur.


    SUPPLEMENTARY TREATMENTS 

    In fertility treatment, there are a number of supplementary measures (add-ons) that may be relevant to include in certain cases. Add-ons are typically used if standard treatment has not been successful and are therefore not the first choice for all treatments. We will always review the rationale for choosing an add-on for a given treatment. Add-ons are usually associated with an additional cost (see price list), but in some cases, they involve medical treatment that can be prescribed.


    We have chosen to offer the following add-ons in our clinic:


    Zymot

    Zymot is a sperm preparation method used to select and purify sperm for IUI, IVF, or ICSI treatment. The method uses microporous filter technology to selectively remove weaker and less motile sperm, while retaining the most active and healthiest sperm. This improves the chances of successful fertilization by ensuring that only the best sperm are used to fertilize the egg.


    Calcium ioniphore

    Calcium ionophore is a medium used in fertility treatments to stimulate the egg’s metabolism after fertilization. It is especially used in ICSI treatment when the egg does not respond naturally to fertilization. Calcium ionophore helps increase calcium levels in the egg, which can promote the necessary processes for embryo development and prevent abnormal cell division. The method is often used for eggs with low fertilization quality.


    EmbryoGlue

    EmbryoGlue is not actually glue, but a solution containing hyaluronic acid, used during blastocyst transfer into the uterus. EmbryoGlue supports implantation by making it easier for the blastocyst to attach to the uterine lining. The high concentration of hyaluronic acid makes the solution thicker, more similar to the natural environment in the uterus. For some patients, use of EmbryoGlue may increase the chance of a positive pregnancy test.


    Assisted HAtching (AHA)

    When the fertilized egg becomes a blastocyst, it needs to “hatch” from its surrounding shell (zona pellucida) to implant in the uterine lining. Assisted hatching is performed in the laboratory by creating a small opening in the shell without damaging the blastocyst’s cells. There is no definitive scientific evidence that AHA increases pregnancy rates, but it may be considered in cases where the embryologist notes a thick shell, if the woman is 38 or older, or after several transfers of good quality blastocysts without pregnancy.


    Priming

    Priming is a superficial scratching of the uterine lining. The theory is that this can trigger repair processes that make the lining more receptive to embryo implantation. Priming is performed in the cycle before a planned transfer. A thin catheter is inserted into the uterus to remove a small sample of tissue. The procedure takes a few seconds and may cause brief discomfort.

    There is no solid scientific evidence that priming increases pregnancy rates, but it may be indicated after several unsuccessful transfers of good quality blastocysts.


    Triotest

    The Triotest examines the composition of the uterine microbiome, ideally with a high proportion of Lactobacilli (lactic acid bacteria) and no pathogenic bacteria (chronic endometritis), and also checks if the timing of blastocyst transfer is optimal for the individual.


    The test is typically offered to women with several unsuccessful transfers of good quality blastocysts or repeated pregnancy loss. If Lactobacilli are below 90%, probiotics are recommended in the next cycle. If pathogenic bacteria are found, antibiotics may be added. If the optimal timing for transfer is different than previously done, this can be adjusted in a future cycle.


    Dalacin (clindamycin)

    Some women may have an “unfavorable environment” in the vagina or uterine lining, possibly due to an excess of harmful bacteria, which can make it harder to become pregnant or cause miscarriage. If there have been several unsuccessful transfers or repeated miscarriages, treatment with Dalacin may be considered in the same cycle as the planned transfer.


    Prednisolone

    Prednisolone is a corticosteroid naturally found in the body. It is used for its immunosuppressive effects, particularly in women with repeated pregnancy loss, autoimmune disease, or endometriosis. Prednisolone is given in a low dose for a short period and rarely causes side effects.


    Acupuncture

    Acupuncture can be a great supplement to support fertility and help bring body and mind into balance.
    The acupuncture needles influence the body’s energy pathways and have a positive effect on helping the body relax, find balance, and open up. This can make a big difference during a fertility journey and is both natural and medically supportive.
    See more information here.

    We are ready to help!