Treatment of infertility

Infertility examinations begin in outpatient health care, for example, at a health center, occupational health care provider, or a private physician’s appointment. If the referral criteria for specialized healthcare are met, a referral is made to a gynecological outpatient clinic. The referral will either be accepted or returned if the criteria are not met or if the referral is incomplete. If your referral has been returned, you can ask the referring unit for reasons behind this.

After the referral has been accepted, you will either receive instructions at home to undergo further examinations or an appointment to see a physician directly.

Fill in the preliminary information form before the appointment. At the appointment, the physician will discuss your state of health, current medication, allergies, and lifestyle. 

We always invite the couple to attend the first appointment together. The woman undergoes a gynecological examination and, if necessary, the spouse is also examined. We examine the fallopian tubes for blockages if necessary.

After the appointment, further examinations, such as blood testing, may be necessary. The Act on Assisted Fertility Treatments requires that we screen for infectious diseases (HIV and hepatitis) before any fertility treatments.

In the case of a couple visiting the appointment together, both will need to pay an appointment fee.

After the first visit, the treatment plan will be individual and will depend on the patient’s or couple’s lifestyle, health status, and the underlying infertility factors. The most common options are as follows:

• No reason is found for the infertility, i.e., it is a case of unexplained infertility. Even one in four couples will receive this diagnosis. If the duration of the attempts to become pregnant is not very long, it is likely that pregnancy will start naturally over time. The couple will continue to try for a pregnancy at home until an agreed time point, after which fertility treatments will be started if the attempts have not led to a pregnancy.
• The treatment is started with medication that provides mild support for ovulation. If necessary, the treatment is also combined with artificial insemination. If you are using the digital MyPath, go through the material included in the service carefully before the appointment for IVF planning.
• The treatment proceeds directly to IVF. Due to the high demand for IVF treatment, there is a waiting list with a varying waiting time of 3 to 6 months. Before starting treatment, the IVF is planned in more detail at a specialist’s appointment. If you are using the digital My Path, go through its material carefully before the IVF planning appointment.
• Further examinations or treatment is needed. You will be instructed to book an appointment for the examination yourself or an appointment with a specialist will be booked for you and an invitation sent to your home by mail. If you have been referred for blood testing, visit the laboratory to have your tests taken before your next appointment.
• Patients wishing to receive treatment with donated gametes will participate in donation counseling with a psychologist, as required by law, and the treatment decision will be made after the counseling and an evaluation. 

Ovulation induction treatments are designed to induce or strengthen ovulation. In the treatment, the woman uses medication as tablets or injections according to the instructions she has received from the clinic. Treatment is combined with either sexual intercourse or insemination scheduled at the time of ovulation.

In an insemination, washed sperm is injected into a woman’s uterine cavity at the time of ovulation.

Insemination treatment is usually carried out in a menstrual cycle supported by hormone therapy (tablets or injections). In treatment with donated sperm, where there is no medical reason on the background, the insemination can also be carried out within the patient’s own menstrual cycle.

In practice, the insemination is scheduled at the time of ovulation, either according to the woman’s positive ovulation prediction test or according to a timed “release injection” to trigger ovulation. As ovulation approaches, we recommend that the couple has intercourse every couple of days. This will significantly improve the success of the treatment. 

On the day of the insemination, the man will deliver a semen sample to the sperm laboratory, where the sample undergoes a washing procedure. The purpose of washing is to separate the most motile sperm for injection into the uterus. In certain situations, it is possible to use donated sperm which has been frozen for storage at the Sperm and Egg Bank prior to the treatment.

The washed sperm are introduced into the uterus with a thin flexible catheter over a time of a few minutes. The procedure is usually painless. If the amount of motile sperm remains very small after the washing procedure, the treatment will proceed with IVF depending on the situation.

In in vitro fertilization (IVF/ICSI), hormone injections are used to stimulate the simultaneous growth of several follicles. A woman injects the drug herself for approximately 10 days. We monitor how the ovaries respond to the treatment with 1 or 2 ultrasound examinations.

An ultrasound guided needle is used to extract the ovum from each mature ovary follicle through the vagina to a test tube. You will be given an effective sedative and painkiller for this procedure. The procedure takes about 5 to 10 minutes. You will be given sick leave for the day of the procedure and the following day.

On the day of harvesting the eggs, the semen sample must be delivered to the sperm laboratory, where the sample undergoes a washing procedure. After the extraction, the eggs are fertilized in the laboratory. Donated sperm can also be used in the treatment. We monitor the development of the embryos for a few days, after which an embryo is transferred to the uterus to grow. If more than one embryo of good quality develops, the other embryos are frozen.

The embryo obtained in IVF/ICSI treatment is frozen and, after thawing, it is transferred to the uterus in either a natural or medically supported menstrual cycle.

Surgical treatment may be required before or during infertility treatments, for example, in situations where the cause of infertility is endometriosis or myoma.

For infertility treatments, you will need a referral from your primary healthcare provider. Further information is available here.

• If you have frozen embryos after childbirth, a new referral is not needed. Please contact the Reproductive Medicine Unit’s advice and appointment booking number 09 471 72882 (call-back service open on weekdays from 7:00 to 11:30 a.m.).
• Embryo transfers can continue no earlier than one year after giving birth.
• Before the planning appointment, breastfeeding should have stopped and the menstrual cycle should have started (excluding women with menstrual problems).
• A planning appointment will be booked for the couple.
• In the case of a wish for a new pregnancy with fertility treatment in a situation where there are no more frozen embryos, a new referral is required for treatment.

If your referral has been returned, you can ask the referring unit for reasons behind this.

Read more about the first visit here.

The sperm laboratory at the Reproductive Medicine Unit in Tilkan Viuhka is open by appointment only. You will receive more detailed instructions in the appointment letter or via Maisa.

You will be directed to provide a sample either in the room reserved for sampling at our unit or alternatively at home.

If you take the sample at home, you can pick up a sample container either from the sperm laboratory during office hours or from the info desk at Women’s Hospital, which is open around the clock. Please deliver the sample container tightly closed and with your name indicated on the container to the sperm laboratory within one (1) hour of taking the sample. The sample container should be kept upright during transport and protected from temperature fluctuations.

To obtain a good, high-quality sample of semen, please ensure that at least 1–2 days have elapsed since your previous ejaculation. After you have carefully washed your hands and penis with water, you can deposit the sample directly into the container by masturbating. Please deposit all of the ejaculated semen in the container, as a varying number of sperm is released at different stages of ejaculation. If providing the semen sample is not possible by masturbating, you can take a sample during intercourse by using a specialized collection condom available at the sperm laboratory. Do not use lubricants or a regular condom because they contain chemicals harmful to sperm.

Read more about the course of the treatments here.

General information about fertility and  fertility treatments can be found on the Women’s Hub website.

Due to the high demand for IVF treatment, there is a waiting list with a varying waiting time of 4 to 6 months. There is no queue for ovulation induction and insemination therapy, but sometimes the treatment cannot be started immediately due to a shortage of appointments. The waiting time for treatments with donated gametes varies depending on the availability of gametes. 

If you receive a referral to laboratory tests, our physician has ordered further testing for you before your appointment. Read more about laboratory tests here.

About 80 percent of those who come into our unit for examinations become pregnant, either through treatments or naturally. The probability of success of fertility treatments is individual and it is influenced by, among other things, lifestyle, underlying reason for the infertility and age. Old age is the most significant factor that reduces the chances of successful treatments. Read more about the results of infertility treatments here. 

When an appointment is booked for the couple together, both will need to pay an appointment fee.

In matters related to storing your sperm, eggs, or embryos, and renewing or terminating a storage agreement, please send an email to sailytyssopimukset@hus.fi.