UZ Brussel-VUB - Patient Support at the CRG

Patient Support at the CRG

When coming to the CRG for a treatment for the first time, you will be asked to fill in a questionnaire regarding your medical history and family status. You can download the questionnaire here, print it and fill it out in advance: questionnaire woman, questionnaire man. You will need Adobe Acrobat Reader, which can be downloaded from this address: http://www.adobe.com/products/acrobat/readstep2.html.

Preliminary investigations

Counsellors

Daily monitoring

Pre-operative blood tests

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Good advice in advance

Click on Lifestyle if you want to know how you can improve your chances of getting pregnant.

Click on Folic acid if you want to read about what every women trying to get pregnant, should know.

During your entire treatment, you will be professionally guided by people from the CRG team. They will consist mainly of your fertility doctor and your counsellor: the nurse responsible for information, follow-up and guidance regarding your case.

Preliminary investigations

Because both the man and woman play crucial roles in reproduction, they will both be subject to a variety of examinations before the commencement of treatment. Which particular methods of investigation are appropriate for you and your partner will be determined by your doctor during the first consultation.

To avoid unnecessary investigations, it is important that you provide your doctor with the results of any previous investigations and all relevant medical information with you. As a patient you can at any time request a copy of your medical file, whether it is kept by your general practicioner, your gynaecologist or at the hospital where you have been treated. The current legislation allows you to make this request yourself. The examinations the doctor feels are necessary can be carried out at UZ Brussel or elsewhere. If the examination is done elsewhere, the CRG doctor will provide you with an application form. If the examination is done at UZ Brussel, you will make an appointment with the UZ Brussel day clinic (see contact).

Important information

Following the new Belgian law on tissue banks, the HIV, hepatitis B and C and sy-philis screening is repeated for every new IVF/ICSI attempt. Before the start of each new treatment, we have to know the infec-tion test results for each patient pro-viding tissue (eggs, sperm cells, embryos).
This means that the man's presence is almost always required on the day of the pick-up. Only if he has supplied his sperm sample in advance to have it frozen of if donor sperm is used in the treatment does he not have to attend.

Preparatory blood investigations

Every fertility treatment is preceded by blood testing (see practical). This allows us to determine hormone balances, to check chromasomal structure and presence of antibodies such as against Hepatitis, HIV and syphilis. Women are also screened for exposure to Rubella and Toxoplasmosis. Both of these conditions can lead to serious damage during early pregnancy.

Sperm analysis
Because the fertility of a man is determined for the largest part by the number of sperm cells present in his semen and the motility and form thereof, all three of these elements will be determined, (see routine sperm analysis) in order to establish whether there are sufficient sperm cells available to fertilize the egg cells in the lab. Three to five days of abstinence are required before the production of a sperm sample (see practical information). A sperm sample is produced by masturbation in a designated room, with the aid of your partner if you so wish. The sample may also be produced at home, provided that it is delivered to the lab within an hour in a special container. For this, you have to make an appointment with the andrology lab beforehand (see contact). Care must be taken to maintain the sample at body temperature during transit, for example by placing the container in the inside pocket of your jacket.

additional examinations
Depending on your specific medical situation, additional investigations may be required. See overview for men and women.

The counsellors

In Meeting with counsellor

Approximately five to six weeks after completion, the results of all the preliminary tests will be known. A second appointment will be made at the centre, during which the gynaecologist who examined you on your previous visit will discuss these results with both of you and propose a specific approach and timetable for yor treatment. You then need to make an appointment with your counsellor for an information session on your treatment from various perspectives. During this mee-ting, the counsellor will discuss:

the practical aspects, such as the start date and consultation with the planning officer, opening times, the process for making appointments at the CRG, where and when which intervention takes place, etc.;

the medical side: what your treatment entails, which medication you will be taking, how you should administer it and how you should prepare for an intervention;
your communication with the CRG: with the Daily Patient Monitoring (DM) during your treat-ment, and with the follow-up team afterwards in case of a pregnancy;
the legal aspects, such as the contracts and consent forms you have to sign; and
the financial side of the matter with information on the conditions for treatment reimbursement for Belgian patients entitled to national health insurance.

The CRG offers two counselling formulas to choose from:

There is private counselling, during which you discuss the above with your counsellor in a personal meeting lasting about one and a half hours.
There is group counselling organised for no more than six couples together and lasting about two hours. One and a half hours of this is spent on a structured presentation about your
treatment and general information. Then every couple is given the opportunity to have a brief personal consult of about ten to fifteen minutes. This gives the counsellor the opportunity to answer certain personal questions and spend some time discussing your specific treatment schedule in some more detail and focusing on your situation. This can differ considerably from
patient to patient.

During the whole treatment, the counsellor will be your confidential contact person, whom you can contact at any time during office hours, for advice and information. Through their vast experience, your counsellor will be able to guide you through practical, physical or psychological problems. If necessary, your counsellor will make additional appointments for you with your doctor, or with the psychologist at the CRG. He or she will also be there to help you through additional treatment attempts.

For some aspects of your treatment, you will be on the ward VP03 at the CRG. Here, the role of your counsellor will temporarily be taken over by the nursing staff on the ward.

Medical and practical

During the meeting with the counsellor, the woman will be advised to start taking folic acid, once you have decided to go ahead with fertility treatment. See Folic acid for more information.

The counsellor will address all medical and practical aspects of the treatment:

the medication scheme;
the woman will receive instructions about how the injections are to be given, or how she can administer them to herself or let her partner administer them to her;
you will be given a number of documents: prescriptions, investigation request forms etc;
you will also receive informative forms which will provide you with practical information regarding specific investigations or treatment.
financial aspects of treatment will be addressed;
finally, the consent forms which belong to a fertility treatment will be explained and you will be required to sign these before treatment commences.

Daily monitoring

Daily Monitoring of individual patients.
Chart illustrating a patients' treatment.

Hormonal stimulation and ultrasound scans are both unavoidable components of IVF treatment. Via hormonal analysis of blood samples (see also blood tests) the treatment is constantly updated and adjusted or 'monitored'. The same goes for ultrasound scans (see practical information). With this painless technique, the stage of development of the follicles in the ovaries is followed.

The part of the CRG which coordinates and communicates the results of these examinations is called the Daily Monitoring (DM). At a certain phase of your treatment, you will be in daily contact with this department. They will call you in order to give you the necessary information about the examination results and instructions regarding the continuation of your treatment.

Pre-operative blood tests

Pick-up, the procedure whereby the ripe egg cells are collected, takes place under local anaesthetic and does not require any pre-op blood tests. In the unlikely case that the pick-up needs to be done under general anaesthetic, due to either personal choice or medical reasons, pre-operative blood investigations will be required (see blood tests).