Having trouble conceiving?

Most couples manage to conceive naturally, although how long this takes may depend on various factors. Figures show that out of 100 couples trying to conceive:

• 20 will conceive within one month
• 70 will conceive within six months
• 85 will conceive within one year
• 90 will conceive within 18 months
• 95 will conceive within two years¹

However, for some people, medical assistance may be necessary to give them the best chance of planning their family.

This section looks at: 

• Who should I / we contact and when?
• Tests and treatment
• Information about kinds of tests and treatment
• Until what age can treatment be given?
• Are there restrictions on who can be treated? (e.g. single women, lesbians)
• Costs and insurance
• Complementary therapies
• Other useful information 
  
• Support groups in Belgium
• Links to general and Belgium-specific info 

Who should I / we contact and when?

Women under the age of 35 (who have no reason to think that they or their partner may have fertility issues) are often encouraged to seek medical advice after one year of trying to conceive.

Women over 35, or women/couples who have reason to suspect that they have fertility issues, are encouraged to seek help sooner.

In Belgium, you might decide to visit your family doctor, midwife or gynaecologist for some initial tests, e.g. blood tests, sperm analysis etc. He/she may then direct you towards a fertility clinic or a more specialised gynaecologist/reproductive endocrinologist for further investigations and/or treatment if necessary. You may also decide to contact a fertility clinic directly, and you do not need a referral to do so.

 

Fertility clinics

In Belgium there are two types of fertility clinic:

• type A clinics, which offer fertility treatments until and including egg retrieval, and then send you a type B clinic for the embryo transfer
• type B clinics, which offer all kind of fertility treatment, including embryo transfer

As you may have to go to the clinic for regular tests/treatments, it can be a good idea to choose one relatively close to where you live or work. 

There are 14 A clinics, and 17 B clinics in Belgium.

In Brussels and the surrounding area, these are:

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For a full list, see http://www.jeveux1bebe.be/examens-et-diagnostics/centres-a-et-b.

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Tests and treatment

Where can I read more about the kind of tests and treatment available in Belgium?

Several fertility clinics in Belgium have produced very informative websites and other documentation.

The Leuven university fertility centre provides a particularly comprehensive patient information brochure (in English), which should provide answers to most of the questions you might have about the potential causes of fertility problems and the available tests (for men and women) and treatments.

Other English-language sources are:

• The Centrum voor Reproductieve Geneeskunde (CRG or Centre for Reproductive Medicine) at the Universitair Ziekenhuis Brussel (UZ Brussel) has put together a very informative website about fertility issues in men and women (website in English). As well as explaining the various procedures in detail, it also gives practical information about how treatment is organised at the CRG at UZ Brussel.
  
  
• The website of the fertility centre in CHU Saint Pierre explains treatment options, including estimated costs.
  

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Is 'mini-IVF' available in Belgium?
While mini-IVF is not typically offered as a possible treatment in Belgium, it may be possible to find doctors in Belgium who are prepared to carry out this method of IVF which uses lower doses of ovarian stimulants.

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Are there restrictions on who can be treated?
Unlike in some countries that impose restrictions on who can undergo fertility treatment, in Belgium, single women and lesbian couples can undergo fertility treatment with the use of donor sperm (or egg cells, if required).

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Until what age can treatment be given?
In Belgium, fertility treatments are available to women over 18 years of age - on special request, and for specific medical reasons, it may be possible to retrieve eggs from a girl under 18 years of age. The upper age limits apply: 

Source: http://www.uzleuven.be/node/2538

Note: Reimbursement under the Belgian health care system for IVF/ICSI, artificial insemination and ovulation induction with gonadotropins is only possible for women under the age of 43 (note: this is soon to be lowered to 41). Read more about Costs and insurance.

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Glossary

See Leuven university fertility centre’s comprehensive patient information brochure (in English) for a much more detailed overview of the various procuedures.

In Vitro Fertilisation (IVF): During IVF, one or more eggs (either the woman’s own or from a donor) are brought together with sperm (from either the woman’s partner or a donor) in a laboratory. The aim is that mobile sperm will spontaneously fertilise one or more of the eggs. If fertilisation happens, the embryos continue to grow in the laboratory for several days, after which one or more are transferred to the woman’s uterus.

Intra-Cytoplasmitic Sperm Injection (ICSI): If the quantity of sperm is low, or is the sperm are not very mobile, ICSI may be performed instead of IVF. With ICSI, each egg is injected individually with a single sperm. If fertilisation happens, the embryos continue to grow in the laboratory for several days, after which one or more are transferred to the woman’s uterus.

Ovulation induction with gonadotropins / ovarian stimulation: This may be done with one of the following goals: - for women who do not ovulate on their own, or who have irregular cycles, the goal may be to ensure that at least one ovum matures per cycle - for women who require IVF or ICSI, the goal is super-ovulation, whereby not one but eight, ten, twelve or more ova mature simultaneously. This can increase the chance of success with IVF or ISCI treatments. Various types of drugs may be used, depending on your situation, and the desired outcome.

Fertility surgery: Various procedures are possible to either: - investigate a woman’s reproductive system, e.g. check the inside of the uterus and the openings of the fallopian tubes, take a sample of the uterine membrane for testing; or - correct issues that may be making conception difficult/impossible, e.g. correcting anatomical abnormalities, removing/empty cysts, removing fibroids, repairing blocked/damaged fallopian tubes, reversing male/female sterilization, removing uterine tissue damaged by endometriosis etc.

Artificial insemination: After ‘filtering’, the most mobile sperm (from either the woman’s partner or a donor) are introduced directly through the cervix into the uterus using a fine catheter/tube. 

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How many embryos can be transferred for IVF/ICSI?

Since 2003, the number of embryos that can be transferred for IVF/ISCI is defined by law, and depends on the age of the woman and how many cycles of IVF/ICSI she has undergone:

* if embryo quality is a worry, two embryos may be transferred

Source: http://www.brusselsivf.be/media/docs/formulieren/INFO-MUT-E.pdf

Worth reading: http://www.kuleuven.be/english/news/belgian-model-of-in-vitro-fertilization-ready-for-worldwide-export

“Doctors often transfer too many embryos in fertility treatment, posing a health risk to both mothers and babies. A new study by researchers at KU Leuven and University Hospitals Leuven shows that restricting the number of embryos transferred and coupling this treatment with a policy of reimbursement has no detrimental impact on pregnancy or delivery rates and greatly reduces the chances of multiple births.”

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Costs and insurance

If you are covered by the Belgian social security system, a large part of the costs related to fertility consultations, tests and fertility surgery is covered by your mutuelle. Hospitalisation insurance is not usually necessary, as overnight hospital stays are not usually required.

In the case of IVF/ICSI, artificial insemination and ovulation induction with gonadotropins, costs are only reimbursed for women under the age of 43 (note: this is soon to be lowered to 41).

If you are not covered by the Belgian system, you will be liable for all costs related to your treatment. In this case, the following link from the French-language support site NatiSens may be useful, as it outlines the cost of many of the drugs that are involved in fertility treatments: http://www.natisens.com/Articles/Administration/Prix_medocs.html.

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How many cycles of treatment are covered by the mutuelle and how much will I still have to pay?

Since 2009, and for women under the age of 43, the Belgian health care system reimburses a large part of the costs related to 6 cycles each of:

• In Vitro Fertilization (IVF) / Intra-Cytoplasmitic Sperm Injection (ICSI);
• egg donation (i.e. costs incurred by the receiver of the eggs)
• other fertility treatments like ovarian stimulation with gonadotrophins (note: stimulation with Clomid is not restricted in the same way) and artificial insemination

Laboratory costs and most of the cost of ovarian stimulation drugs are reimbursed. The outstanding costs include the ‘ticket modérateur’ (i.e. non-reimbursable part) of any costs that are covered by the mutuelle, including consultation costs, blood tests, ultrasounds, other medications, etc.

For IVF/ICSI, and depending on your personal situation, the cost to you may still be between €300 to €500 per cycle. Make sure to investigate any health insurance policies you have, so that you can claim any assistance you are entitled to.

This document from The Centrum voor Reproductieve Geneeskunde (CRG or Centre for Reproductive Medicine) at the Universitaire Ziekenhuis Brussel (UZ Brussel) gives a good overview of the costs involved for IVF/ICSI: http://www.brusselsivf.be/media/docs/formulieren/INFO-MUT-E.pdf

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How do I benefit from these reimbursements?

To be reimbursed for cycles of IVF / ICSI, egg donation, or other fertility treatments like ovarian stimulation with gonadotropins and artificial insemination, your gynaecologist will need to provide you with the relevant form that needs to be submitted to the ‘medecin-conseil’ for approval.

If your request is approved, you will then receive an official form which needs to be stamped by your care provider each time you begin a treatment cycle. Note: All drugs related to these treatments need to be provided by the hospital/fertility clinic’s own pharmacy.

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Complementary therapies

While complementary therapies may not cure infertility, many couples like to supplement medical treatment with other approaches.

Some popular therapies include:

• Acupuncture: see the website of the Belgian association of doctor acupuncturists for lists of acupuncturists per region (site in French/Dutch but easy to navigate)
  
  
• Reflexology: see the website of the Centre d’Etude de Réflexologie for a list of reflexologists in Brussels, Brabant Wallon and Wallonia (site in French but practioners listed clearly)
  
  
• Homeopathy: see the website of the Unio Homeopathica Belgica for a list of doctors who practice homeopathy, per region (site in French/Dutch but easy to navigate)

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Useful information

Support groups and counselling in Belgium

• Many fertility clinics offer fertility counselling with a psychologist, whether before or during fertility treatment. Counselling may be individual or per couple, or group sessions may also be available. If your care provider does not mention counselling, ask what services are available.
  
  
• The BCT has a support group for anyone considering or undergoing IVF or other assisted reproductive treatments - open to non-BCT members.
  
  
• Nati-Sens – a French-language website that has an active forum

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Other useful links

General

http://www.babycentre.co.uk/c1005212/treatments-for-infertility (English)

Belgium-specific

• The Leuven university fertility centre has produced a comprehensive patient information brochure (in English), which should provide answers to most of the questions you might have about the potential causes of fertility problems and the available tests (for men and women) and treatments.
  
  
• The Centrum voor Reproductieve Geneeskunde (CRG or Centre for Reproductive Medicine) at the Universitair Ziekenhuis Brussel (UZ Brussel) has put together a very informative website about fertility issues in men and women (website in English). As well as explaining the various procedures in detail, it also gives practical information about how treatment is organised at the CRG at UZ Brussel.
  
  
• The website of the fertility centre in CHU Saint Pierre explains treatment options, including estimated costs.
  
  
• http://www.jeveux1bebe.be (French) / http://www.kinderwens.be (Dutch)
  
  
• http://www.natisens.com/index.htm (French)
  
  
• A list of legislation surrounding assisted reproductive technology in Belgium: http://www.fivette.be/index.php?option=com_content&view=article&id=99&Itemid=85&lang=en
  
  
Most of this legislation is available on the FAMHP website: www.fagg-afmps.be (under 'human use' > 'human body material' > 'legislation')

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