Treatment of infertility

Infertility evaluation begins 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 health care 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.

If you receive a request for blood testing, it means that even though you may have already visited the laboratory before, our physician wants further examinations to be done, such as blood tests and/or a semen sample. You do not need to notify us once you have had your tests, as we will check this in the patient information system. Go and have your tests taken as soon as possible, after which you can wait to be notified of your appointment. Appointments can only be booked after the examinations have been completed.

Fill in the preliminary information form before the appointment. At the appointment, the physician will discuss your health, current medication, allergies, and lifestyle. We always invite the couple to attend the first appointment together. The woman will have a gynecological examination and, if necessary, the spouse will also be 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.

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

After the first visit, the follow-up treatment plan will be individual. 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. There is often a good chance that a pregnancy will start with 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 attempts have not led to a pregnancy.
• The treatment is started with medication that provides mild support for ovulation, and, if necessary, the treatment is also combined with artificial insemination.
• 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 4 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 are 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.

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, 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 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 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. Donated sperm can also be used in 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 according to the situation.

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. Patients will receive an effective sedative and painkiller for this procedure. The procedure takes about 5 to 10 minutes. Sick leave will be prescibed 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 a myoma.

You need a referral to fertility treatments from primary health care. Read more from here.

• If the couple has 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).
• The 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 of the Reproductive Medicine Unit at Tilkan Viuhka is available by appointment only. You will receive more detailed instructions in your appointment letter or via Maisa.

You will be instructed to provide a sample in sampling room at our unit, or alternatively at home.

If you take the sample at home, you can pick up the 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 labelled with your name to the sperm laboratory at your scheduled time 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 specimen 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 the sample during intercourse by using a special 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 assisted fertility treatments is available in Finnish at Naistalo.

Due to the high demand for IVF treatment, there is a waiting list with a varying waiting time of 4 to 6 months. There are no waiting times to ovulation induction and insemination, but sometimes it is not possible to start the treatment immediately due to a shortage of appointments.

If you receive a referral to laboratory tests, our physician wishes to have additional tests taken before your appointment. Read more about laboratory tests here.

About 80 percent of people evaluated in our unit become pregnant, either with help from treatments or naturally. The success rate of fertility treatments is individual, and it is affected by lifestyle, the reason for infertility, and age, for example. Old age is the main reason that reduces the chances of successful fertility treatments.

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.