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What is fertility imaging? These are medical examinations using ultrasound or X-ray imaging to understand infertility or to perform a fertility assessment. Medical services Endovaginal UltrasoundPelvic ultrasound is the first exam performed to assess female reproductive organs. It is performed using a probe inserted vaginally. The number of small follicles, called “antral follicles,” in each ovary is counted. This number provides an idea of your ovarian reserve, i.e., your potential response in case of ovarian stimulation.Several pathologies associated with infertility are also checked:Uterus: presence of fibroids, polyps, or congenital anomalies such as a septum.Ovaries: detection of cysts, particularly related to endometriosis.Fallopian tubes: assessment for hydrosalpinx, commonly called “dilated tube.”This ultrasound is usually performed in the first days of the menstrual cycle.SIS (Saline Infusion Sonography or Hysterosonography)This exam allows visualization of your uterine cavity (endometrium) and uterine walls (myometrium). It is ideally performed at the end of your period, before the 11th day of your cycle. You are positioned gynecologically, and after vaginal disinfection, a soft catheter is placed in the uterus to instill saline solution to detect possible intrauterine pathologies causing infertility. The sonographer explains each step during the exam.HyFoSy (Hysterosalpingo-foam-sonography)This exam is performed in gynecological position after vaginal disinfection to evaluate the patency of the fallopian tubes and detect any pathologies that could explain infertility. It is performed at the end of your period, before the 11th day of your cycle. It requires the injection of a specific foam gel (ExEm® Foam) using a soft balloon catheter placed inside your uterus.It is recommended to take a painkiller one hour before the exam, as it can be painful like heavy periods for some patients.Your prescribing physician will evaluate whether antibiotics are necessary before the exam. A PCR test for chlamydia or gonorrhea in the cervix or urine is useful for prevention. If a tubal pathology is discovered, the sonographer will reassess the need for antibiotics if it has not been done previously. The sonographer explains each step during the exam.Complete Fertility AssessmentThis exam first involves a complete endovaginal ultrasound, followed by a SIS. The catheter used for this exam remains in place and is used for the injection of ExEm® Foam. This allows visualization of both the inside of the uterus and the patency of the fallopian tubes in a single appointment. Ideally, it is performed before the 11th day of your cycle. Prophylactic antibiotics may be prescribed if necessary. It is also recommended to take a painkiller one hour before the exam.Assessment of Vascularization / Endometrial ReceptivityThis exam is proposed in cases of repeated embryo implantation failures.The sonographer examines the vascularization of your uterine arteries and the volume of your endometrium. This exam is ideally performed the week after ovulation or following a specific hormonal treatment prescribed by your gynecologist.If the results are abnormal, the sonographer may propose a treatment of at least three months before reassessing endometrial receptivity.During the second exam, a biopsy of your endometrium may be performed for histopathological analysis to detect acute endometritis. You can discuss with your doctor the relevance of this analysis in your specific case.HysterosalpingographyThis exam tests tubal patency and the shape of the uterine cavity. It takes place in the radiology department since it uses X-rays and contrast medium instilled into the uterus by a gynecologist. The radiologist interprets the images.It is performed at the same time of the cycle and with the same precautions as HyFoSy.It is now rarely prescribed since HyCoSy was developed. Advice Take a painkiller, such as an anti-inflammatory (e.g., Ibuprofen 400) or a spasmolytic like Buscopan, about 1 hour before the exam, as uterine contractions may occur during the procedures.Do not forget your written request signed by your prescribing physician. Focus Our fertility imaging team consists of gynecologists who are also part of the IVF team. You benefit from their dual expertise for detecting abnormalities and understanding your infertility. Our Specialists Appointment procedures for gynecological ultrasound (route 178):For evaluation ultrasounds, SIS, or HyFoSy: call 02/555.36.36 as soon as your period starts to schedule an appointment before the 11th day.For hysterosalpingography: call 02/555 33 12 as soon as your period starts to schedule an appointment before ovulation.Gynecology-Obstetrics ServiceDr. Margherita CONDORELLIDr. Noé MOUTARDDr. David PENINGDr. Mélodie VANDER BORGHTAssociated ServicesRadiology ServicePr SADEGHI MEIBODI NILOUFAR

What is fertility preservation? Unlike men, who can remain fertile later in life, women are born with a predetermined stock of eggs that gradually decreases over time. With age, the quality of eggs also decreases, leading to reduced fertility and lower chances of pregnancy starting around age 30, with a more significant decline after 35.In today’s world, women (and men too) increasingly wish to have children later in life for various reasons (wanting to enjoy life before starting a family, meeting the right partner, economic or professional constraints).There is also widespread lack of knowledge about fertility changes in women. Many believe that medicine will be effective in cases of age-related infertility, which is not entirely true, as only anonymous egg donation can help in this case. The idea of egg preservation is to plan a “self-donation” for the future, with the advantage of maintaining a genetic link. Medical services Oocyte (egg) vitrificationThis rapid-freezing technique allows mature oocytes collected after ovarian stimulation to be preserved intact for future use. These oocytes will be fertilized with sperm from the partner (or a donor). The embryos obtained in the laboratory will be transferred one per cycle into the uterus, with pregnancy chances similar to those at the age of freezing.At Erasmus Hospital, we perform this procedure until the day before your 39th birthday, but oocyte preservation should ideally be done before age 36 to provide the best chance of pregnancy. The ideal age for this procedure is around 32-33, especially if you want multiple children: the first may come spontaneously, but you may need your preserved oocytes for the second.Collected and vitrified oocytes are stored for 10 years, which can be shortened or extended upon request. Regarding the use of these oocytes for a parental project, in Belgium, the maximum age is 45 for the request to fertilize your oocytes and 47 for embryo transfer.In practice, you should contact the clinic before your 38th birthday to schedule appointments with the doctor and psychologist. They will evaluate your request, define your expectations and options regarding the gametes, and provide all necessary information and assessments before considering the procedure.What you should know:This procedure is not fully covered by health insurance: ovarian stimulation treatments and laboratory egg freezing costs are fully at your expense, between €2,500 and €4,000 depending on your personal situation.If your ovarian reserve has already decreased, multiple stimulation cycles may be needed to reach the ideal number of 20 oocytes in storage (90% chance of a child later).“Storage fees” apply from the second year of preservation, also at your expense. A detailed cost estimate will be provided during consultation.Sperm preservationCryopreservation of mature sperm obtained via masturbation has existed for many years and is a “simple” method to preserve male fertility long-term.The most common non-medical reason is vasectomy.You will then have one or more appointments (usually 1 to 3) at the andrology laboratory to collect several samples, which will be stored for 10 years, with the possibility of shortening or extending upon request. Annual storage fees are your responsibility.Depending on the quality and number of samples, artificial insemination or IVF with ICSI may later be considered with your partner. Advice Reverse family planningIt is possible to schedule an appointment at any age with one of our specialized doctors and/or psychologists to receive personalized information on your probable fertility evolution and recommendations for optimal family planning. Focus Fertility evaluation and advice: both women and men can have an assessment of their current fertility and its likely evolution in the coming years. For men, this involves a sperm analysis; for women, Anti-Müllerian Hormone testing and follicle count via gynecological ultrasound. Scientific research Infertility ConsortiumEvaluation of the demand for AGE banking in the Belgian population, contribution of the procedure to birth rates, and reflection on equitable coverage of the process.Dr Catherine HOUBA & Prof Anne DELBAERE Our specialists Erasmus Hospital is a pioneer in oocyte vitrification thanks to numerous internationally recognized research projects conducted by the ULB Research Laboratory and Prof Demeestere.Associated servicesInformation contact:Phone: 02/555 36 89, Monday to Friday, 8:30 – 12:30Email: secmed [dot] fiv [at] hubruxelles [dot] beFor appointments:Phone: 02/555 48 57Gynecology-ObstetricsProf Anne DELBAEREDr Catherine HOUBADr Isabelle DUPONTDr Fabienne DEVREKERDr Serge DELATHOUWERPsychologist team:Chantale LARUELLEIsabelle PLACEDenis WALRAVENS

What is medical fertility preservation? Medical fertility preservation is offered when a disease or its treatment may endanger fertility. Certain treatments, such as ovarian or testicular surgery, chemotherapy, radiotherapy, or certain genetic conditions, can damage the ovaries or testes. These are often cancer treatments that may be harmful to fertility. Such treatments are called “gonadotoxic.”In this context, it is recommended to plan fertility preservation if possible before starting treatment. The medical field that assesses fertility risks and offers preservation techniques in cancer cases is called oncofertility. Oncofertility concerns women and men of reproductive age, as well as adolescents and children.It is also important to know that certain non-cancerous diseases, such as benign hematological diseases (e.g., sickle cell disease) or autoimmune diseases, also require gonadotoxic treatments. Some genetic diseases can be associated with premature ovarian failure or risk of testicular insufficiency. Fertility preservation may also be indicated in these cases. Fertility preservation may also be considered if a surgical treatment risks reducing ovarian reserve, such as endometriosis surgery.The INAMI/RIZIV covers only part of these indications. Medical services Various methods of gamete cryopreservation have been offered at Erasmus Hospital for around twenty years. Cryopreservation is a technique that allows human cells and tissues, including oocytes, sperm, and ovarian tissue, to be preserved long-term at -72°C.Fertility preservation in girls and womenOocyte and/or embryo preservationIf you are a young woman and your gonadotoxic treatment can be postponed for a few weeks, ovarian stimulation may be considered to collect oocytes via transvaginal aspiration. Depending on your preference, these oocytes can be frozen as-is and/or fertilized with your partner’s sperm or donor sperm. Oocytes are stored for 10 years, and embryos for 5 years. Storage periods can be shortened or extended upon request. In case of future infertility, these oocytes or embryos can be thawed and used for pregnancy. As with any assisted reproductive procedure, success cannot be guaranteed. The INAMI/RIZIV covers this procedure up to age 37. In Belgium, the maximum age for fertilization of oocytes is 45, and for embryo transfer 47.Ovarian tissue preservationWhen gonadotoxic treatment must start urgently, has already started, or in adolescents or children, an alternative to oocyte preservation is to harvest an ovarian fragment or whole ovary via laparoscopic surgery under general anesthesia. The goal is to cryopreserve ovarian tissue fragments, which contain a large number of oocytes. This procedure can be offered up to age 36. Storage of ovarian tissue fragments is 10 years, which can be shortened or extended upon request. If there is a desire for pregnancy after recovery, and fertility has been irreversibly affected, the ovarian tissue can be transplanted to restore fertility. Before transplantation, further analysis is needed to exclude tumor cells. Transplantation must occur before age 45. In Belgium, the maximum age for fertilization of oocytes from transplanted tissue is 45, and 47 for embryo transfer. Over 200 children have already been born worldwide using this technique, including several at Erasme Hospital. Success cannot be guaranteed, and this technique is considered innovative.Fertility preservation in boys and menSperm preservationCryopreservation of mature sperm obtained from ejaculate (by masturbation) has existed for many years and is a simple method to preserve male fertility long-term.Depending on your diagnosis and urgency of treatment, you will have multiple appointments (usually 3) at the andrology lab to preserve several samples for 10 years, which can be shortened or extended upon request. In case of infertility following gonadotoxic treatment, the frozen sperm can be used to achieve pregnancy with your partner. Depending on the quality and number of samples, artificial insemination or IVF with ICSI may be considered. If sperm cannot be obtained via ejaculation, a testicular biopsy under general anesthesia may be performed.In children, it is also possible to harvest and store testicular tissue in collaboration with other hospitals. Currently, this technique remains experimental, and no pregnancies have yet been achieved from testicular tissue collected from children. Advice Before starting your treatment or upon diagnosis of a disease, it is important to discuss the possible impact on fertility with your treating physician. You may be referred to one of our fertility preservation specialists, who will inform you about the options according to your personal situation.In Belgium, under certain conditions, fertility preservation procedures may be reimbursed by INAMI/RIZIV for women under 38 and men under 45, if they are insured.

Invoices are sent to you within 6 to 8 weeks of your visit to the hospital. You may receive additional invoices at a later date. Please do not hesitate to contact the billing department by e-mail at facture [dot] facturation [dot] erasme [at] hubruxelles [dot] be, or by telephone on +32 2 555 36 63 for collections, Monday to Friday, 8:30am to 12.30pm. Payment plan If you are experiencing payment difficulties and wish to avoid having your debt collected by compulsory means, the Erasmus Hospital is likely to grant you payment facilities and will determine the number of monthly payments in consultation with you.If you have any questions or comments about your application, a member of staff will contact you within three working days.  Form Coverage The functions of the "collections" section include:Identifying non-payment of invoices on the due date. Planning the reminder procedure. In cases of non-payment for social reasons, a study into the possibility of granting payment facilities. Where necessary, referral of disputed cases to a lawyer or bailiff. If you have any questions about collections, please contact +32 2 555 37 05 or Recouvrement [dot] Facturation [dot] erasme [at] hubruxelles [dot] be (Recouvrement[dot]Facturation[dot]erasme[at]hubruxelles[dot]be).

Signposting at the Erasmus Hospital functions like a road system. Simply follow the route number you are given. If you have any problems finding the right direction or moving around, please go to one of our volunteers at the hospital entrance.  Image Signposting at the Erasmus Hospital functions like a road system.