Table of Contents
4.1 Stimulation of follicular maturation
4.3 Work-up of semen
4.2 Egg retrieval
When the ultrasound scan shows the follicle to be large enough, i.e. approximately 16 - 20 mm and the hormone levels indicate that the follicle is sufficiently mature, ovulation is induced with an intra-muscular injection of 10,000 I.E. HCG. Ovulation would then occur approximately 40 hours later. The follicles are therefore tapped and the ovae taken out approximately 36 hours after this injection. As a rule, unless the mother-to-be lives far away, this is carried out on an out-patient basis, generally in the morning between 8:00 a.m. and noon. Punction typically occurs under ultrasound control through the vagina; in cases of exception (far less than 1 %), laparoscopy is necessary. Anaesthesia is not necessary for tapping under ultrasound control, administration of painkiller providing sufficient relief. Some women (approximately 20 %) request a short anaesthesia for the surgery. During the treatment this will be discussed or you will be given a recommendation which takes your individual situation into account. 4.1 Stimulation of follicular maturation
4.3 Work-up of semen
After the tapping you will be under surveillance for a certain period of time. Before you leave the hospital, an ultrasound scan can ascertain that the punction proceeded without complications.
Fig. 2 Ultrasound-controlled transvaginal egg retrieval.
For persons insured by a private German insurance company, costs of assisted reproduction (IVF/ET) will be borne by the insurance company (ruling by the German Supreme Court, BGH, from 17.12.1986; AZ: IV a ZR 78/85) in accordance with the guidelines for remuneration of physicians, GOÃ„. This also applies to intracytoplasmatic sperm injection (ICSI), if this is the only means to overcome andrologic subfertility/sterility.
The private insurance companies act on the principle of responsibility for causation in taking over the costs for IVF/ET treatment of women, providing the indication for this treatment consists in the man's need for ICSI treatment.
The German statutory insurance companies bear the costs for IVF/ET if it is indicated in the woman only (Â§ 27 a SGB V). Since the beginning of 1999, in spite of medical indications on the part of the woman, the couples must bear all accruing costs, including those for IVF treatment of the woman and the costs for any necessary medication, when intracytoplasmatic sperm injection (ICSI) is also involved.