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BELRAP IVF form 2025

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BELRAP IVF form 2025

Owned by Anna Grace
Last updated: Feb 25, 2025 by Michel Meester
15 min read

If it concerns an IVF cycle, the IVF form will be opened

Tabs

The IVF form has 3 tabs:

  • Cycle development tab

  • Outcome tab

  • MBV tab

Cycle development tab

The cycle development tab has 7 sections:

Administrative data

 

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1

Cycle identification
This needs to be filled in Geplande behandeling.

The cycle indification has 13 characters:

##-####-#####

If any of the following conditions is not satisfied:

  1. Characters 1-2. must be a valid centre number, i.e. equal to ‘01’, ’02’, ’03’, ’04’, ’05’, ’06’, ’07’, ’08’, ‘09’, ’10’, ’11’, ‘12’, ‘13’, ’15’, ‘16’, ‘17’, ‘18’, ’20’, ‘21’, ‘22’, ‘23’, ‘24’, ’25’, ‘26’, ‘27’, ‘29’, ‘31’, ‘33’, ’34’, ’35’, ’36’, ‘37’, ‘38’, ‘39’

  2. Character 3 must be a hyphen.

  3. Characters 4 to 7 must be a valid year, i.e. “2016” to the current year.

  4. Character 8 must be a hyphen.

  5. Characters 9-13 must be positive number.

The caption needs to be changed per client:

  • researchcode - PATCHLABELS.RESCODE

  • Externe code - CAPTION.EXTERNALCODE

2

Int. Cycle identification
This is number is automatically generated by IDEAS

 

3

Riziv/Inami patient
To find out if the patient is covered by national insurance or not.
Characteristics
1 (Yes), 2 (No without E112/S2), 3 (No but with E112/S2), exclusive, compulsory.
Note
Yes = “Belgian Insurance”
No without E112+S2 = "not Yes" + CE + DOSZ/OSSOM + private insurance
No but with E112/S2 = "not Yes" + E112/S2
Used to calculate the number of reimbursable cycles.

This is retrieved from Ander nummer in the Demografische gegevens. Here you can indicate whether the patient is insured or not.

If a number or “Yes” or “Yes” is entered here, “Yes” will appear on the Belrap form.

If “No” is entered here, “No, without E112/E2” will appear on the Belrap form.

If “E112” is entered here, “No, with E112/E2” will appear on the Belrap form.

  1. Yes

  2. No without E112/S2

  3. No but with E112/S2

4

Labo rank
This concerns the number of treatments the patient has already had.
IDEAS bases this on the data entered in the MBV tab and adds one.

  • Used to calculate the number of reimbursable cycles.

  • Cancelled cycles, donor cycles or cycles with 0 oocytes treated by IVF or ICSI should not have a labo rank filled in.

  • For foreign patients without E112/S2, the labo rank based on all previous attempts with a laboratory phase anywhere in the world should be filled in.

  • In case a patient is participating in a clinical trial and therefore is not using one of her reimbursable cycles (i.e. the centre is covering the costs), please leave the labo rank empty.

  • A labo rank must be filled in for the first batch of fertilizations of oocytes originating from a fresh cycle. No labo rank may be filled in for the second or higher batch of fertilizations of frozen oocytes from the same fresh cycle when one does not fertilize all oocytes in one batch. This is to assure that only one attempt will be charged to the patient.

 

 

5

DOB.
The date of birth is fille in Demografische gegevens.
The age must be between 18 and 48 years.

 

6

Residence

  1. Belgium

  2. European union
    The European union includes Austria, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and United Kingdom.

  3. Other

  4. Unknown

This needs to be filled in Bestand > Stambestanden > Lijsten > Land (Algemene patiëntgegevens)

 

image-20250110-132817.png

 

7

Type of family
This depends on the relationship with the partner entered in the Behandelingscycli > Geplande behandeling.
This may differ from the partner entered in the Demographic slice.

  1. Heterosexual couple

  2. Lesbian couple

  3. Single mother

  4. Unknown

  5. Not applicable

  6. Gay couple

  7. Other

Donor cycles should fill in "Not applicable"

 

image-20250110-133046.png

 

Diagnostics

In de diagnostics worden de diagnoses weergegeven.

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  1.  

Diagnostics
What is entered here will be set to Yes on the BELRAP form, and the rest will be set to No in the BELRAP form.

If no diagnosis has been entered here, everything will be blank.
The default is set to blank because it cannot be assumed that the answer is NO.

The Belrap codes for these three options must be entered in Bestand > Stambestanden > Lists > Diagnose codes (ICD9).  

 

  1. Yes

  2. No

  3. Unknown

 

image-20250110-133220.png
image-20250110-133228.png

 

  1.  

10.

11.

12.

13.

14.

Positive serological status female
If the blood test shows a positive result for HIV and/or Hepatitis and/or Syphilis, "Yes" will appear here.
For a negative result, "No" will appear.

If no test has been performed or no result is obtained, the field will be left empty and will turn red with a validation warning.

This was done to draw attention to the fact that there is no result from the test

image-20250110-133351.png

Male Pathology

For the next four options it is important that the BELRAP code is entered in Bestand > Stambestanden > Lijsten > Diagnose codes (ICD9)

image-20250110-133408.png

These fields do NOT need to be completed for:

  • Lesbian couples

  • Single mothers

  • 7. Type of family = "Not applicable"

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15.

Genetic anomaly
This is set to "Yes" if an option is filled in with the BELRAP code "Genetic anomaly (male)"
This is taken from the Diagnosis tab at:

Sec. diag infertility in women

The Progress Notes obtained from the partner at the time of treatment.
This does not have to be the current partner shown in the Demographic slice.

  1. Yes

  2. No

  3. Unknown

This field also does NOT need to be completed for donor cycles.

 

image-20250113-081917.png

 

image-20250113-081924.png

 

16.

Sperm classification
This is taken from the secondary diagnosis infertility infertility and diagnosis tab of the man.

  1. Normal (for latest WHO criteria)

  2. Azoospermia

  3. Abnormal

  4. Unknown

17.

Immunulogic
This is taken from the primary and secondary infertility diagnosis, and male diagnosis tab.

  1. Yes

  2. No

  3. Unknown

18.

Positive serological status male
If the blood tests result is positive for HIV and Hepatitis, Yes will be displayed here.
No is displayed if the result is negative.

  1. Yes

  2. No

  3. Unknown

If no test has been performed or no result is obtained, the field will be left empty and will turn red with a validation warning.

This was done to draw attention to the fact that there is no result from the test

image-20250110-133812.png

 

Cycles

The data for this section is taken from laboratory data.

image-20250110-134002.png

Double-click on the type field to go to the relevant list in Bestand > Stambestanden > Lijsten te gaan.

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19.

Type of cycle.
IDEAS gets this from the Laboratorium gegevens

  1. Fresh
    Fresh own eggs
    Sharing
    Egg recipient
    Fresh egg donor
    Surrogate carrier
    Thawed own eggs
    Thawed donor eggs

  2. Thawed
    Own embryos
    Embryo recipient – donor egg
    Embryo recipient – donor embryo
    Surrogate carrier

  3. Mixed (Fresh & Thawed)

 

20.

(If Fresh)
IDEAS gets this from the Laboratorium gegevens

  1. Fresh own eggs = fresh cycles where the patient's own eggs are fertilized with sperm from partner or donor. This includes the biological mother in case of surrogacy.

  2. Sharing = fresh cycle where one part of the patient's own eggs are fertilized with sperm from partner or donor and the other part is donated for third party reproduction.

  3. Egg recipient = fresh cycle where eggs from an oocyte donor are fertilized with sperm from the recipient's partner or a sperm donor.

  4. Fresh egg donor = fresh cycle where eggs are donated for third party reproduction.

  5. Surrogate carrier = fresh cycle where embryo(s) originating from another woman are transferred into the surrogate carrier. This cycle only needs to be filled in from the transfer field.

  6. Thawed own eggs = fresh cycle where thawed own eggs are fertilized with sperm from partner or donor.

  7. Thawed donor eggs = fresh cycle where thawed donor eggs are fertilized with sperm from partner or donor.

  8. Fresh and thawed own eggs = fresh cycle where the patient's own eggs are fertilized with sperm from partner or donor. The eggs are obtained from a combination of new obtained

 

21.

(If thawed)
IDEAS gets this from the Laboratorium gegevens
This will only be calculated automatically if "Own embryos" is entered, otherwise it must be entered manually.

  1. Own embryos = thawed cycle where own thawed embryo is transferred.

  2. Embryo recipient - donor egg = thawed cycle where thawed embryos originating from an egg donor are transferred.

  3. Embryo recipient - donor embryo = thawed cycle where thawed embryos originating from an embryo donor couple are transferred.

  4. Surrogate carrier = thawed cycle where thawed embryo(s) originating from another woman are transferred into the surrogate carrier.

 

22.

Start date of stimulation
The start date is removed from the treatment plan.
If this is not filled in, IDEAS fills in the first date of the FSH medication.

image-20250110-134627.png

23.

Pituitary inhibition (hypofyse remming)
This is retrieved from the Onderdrukkings protocol under the Verrichte behandeling and otherwise the Geplande behandeling.

  1. Agonist – long

  2. Agonist – short

  3. Antagonist

  4. None

  5. Progestin-primed ovarian stimulation (PPOS)

 

image-20250110-134646.png

 

24.

Stimulation with Clomiphene/Letrozole
If a medication with the following Belrap code has been entered in the medicijnen protocol field, the correct option will be filled in

  1. Yes, Clomiphene

  2. No

  3. Unknown

  4. Yes, Letrozole

Clomiphene

  • Clomiphene (CC)

  • cc + Gonadotrophins combined recombinant and urinary

  • cc + Gonadotrophins Recombinant

  • cc + Gonadotrophins urinary

Letrozole:

  • Letrozole

 

image-20250115-124841.png

 

25.

Stimulation with Gonadotrophins
If a medication with the following Belrap code has been entered in the medicijnen protocol field, a Yes will be displayed here:

  1. Yes

  2. No

  3. Unknown

  • Gonadotrophins combined recombinant and urinary

  • cc + Gonadotrophins combined recombinant and urinary

  • Gonadotrophins Recombinant

  • Gonadotrophins urinary

  • cc + Gonadotrophins Recombinant

  • cc + Gonadotrophins urinary

  • AI + Gonadotrophins Recombinant

  • AI + Gonadotrophins urinary

  • Long acting FSH 100 + Gonadotrophins recombinant

  • Long acting FSH 150 + Gonadotrophins recombinant

  • Long acting FSH 100 + Gonadotrophins urinary

  • Long acting FSH 150 + Gonadotrophins urinary

 

26.

Substitution cycle
If a medication has been used with Sustitution entered in the Belrap code, a Yes will be displayed here:

  1. Yes

  2. No

  3. Unknown

 

image-20250110-135137.png

 

27.

Spontaneous/modified cycle
If a medication has been used with None(Spontanous cycles) entered in the Belrap code, a Yes will be displayed here:

  1. Yes

  2. No

  3. Unknown

 

image-20250110-135148.png

 

28.

Other stimulation
If a medication has been used with None(Spontanous cycles) entered in the Belrap code, a “Yes” will be displayed here:

If one option is filled in, the rest will be set to “No”.

  1. Yes

  2. No

  3. Unknown

 

image-20250110-135156.png

 

29.

Total dose of ganodotrophins
These are all used and confirmed "FSH drugs" in associated test.
Confirmation must be done in Wijzig behandelplan

image-20250110-135210.png

 

30.

Ovulation trigger

 This needs to be filled in the Behandelingsplan tab

  1. None

  2. HCG

  3. LH

  4. GnRH agonist

  5. Irrelevant

  6. Dual trigger

 

image-20250113-085747.png

31.

Cancellation
This needs to be filled in the Behandelingsplan tab

  1. Yes

  2. No

In the event of an aborted cycle, the following questions must be answered:

32.Cancellation cause

64./70 Complications

The rest of the fields no longer need to be filled in.

 

image-20250110-135239.png

 

32.

Cancellation cause
Enter the reason for aborting the cycle.

  1. Insufficient ovarian response

  2. Premature LH and/or rising progesterone

  3. OHSS risk

  4. Other medical reason

  5. Non-medical reason

Fresh Cycles

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33.

Date of pickup

The field is used for two options:

  • For fresh cycles the puncture date must be entered

  • For a cycle in which frozen eggs are thawed, the date of thawing / fertilization must be entered

This is retrieved from treatment plan of  behandelingscycli.

image-20250110-135902.png

34.

Number of cumulus oocytes retrieved or oocytes thawed
These are the collected eggs and are taken from the Laboratorium gegevens.

If no eggs have been collected in a 19. Type of cycle = Fresh (no Egg recipient), questions should be 64./70. Complications answered.

The rest of the fields no longer need to be filled in

image-20250110-135942.png

 

 

 

 

35.

In-vitro maturation (IVM)
If lab procedure IVM has been applied in Laboratorium gegevens.a, a Yes will appear here, otherwise standard No.

36.

Site where Embryology.
This is the clinic number where embryology was performed.
This is entered automatically (only with a fresh cycle.)

Error

If value is different from ‘01’, ’02’, ’03’, ’04’, ’05’, ’06’, ’07’, ’08’, ‘09’, ‘12’, ‘13’, ’15’, ‘16’, ‘17’, ‘18’, ‘22’, ‘23’, ‘24’ or its numerical equivalent.

37.

Number of oocytes donated
The number of oocytes donated.

38.

Number oocytes received
The number of oocytes received or thawed.

39.

Number of oocytes inseminated (IVF)
The number of the oocytes retrieved that were inseminated by IVF.. (Embryo nr. 11)

40.

Number of oocytes injected (ICSI)
The number of the oocytes retrieved that were inseminated by ICSI.. (Embryo nr. 1 t/m 10)

41.

# oocytes frozen
Enter the number of eggs that will be frozen.

Select the event "Vriezen van embryo's" with Fase "Eicel".

image-20250110-140334.png

42.

Origin of sperm
This needs to be filled in sperma analyse.

If the semen source is not the same as entered in Geplande behandeling, donor is entered.

1. From the partner
1. Fresh
1. Ejaculated
2. Surgically retrieved
2. Thawed
1. Ejaculated
2. Surgically retrieved

2 From a donor
1. Anonymous
2. Known
3. From partner and donor
4. Co-parent

If "From the partner" is filled in, the questions should be:
43. Origin of sperm, Fresh / Thawed (If from partner) and
44. Origin of Sperm, If partner ejaculated/surgical retrieved to be completed.

If "From a donor" is completed, question 45. Origin of Sperm, If from donor must be completed.

image-20250110-140421.png

 

image-20250110-140429.png

 

43.

Origin of sperm, Fresh / Thawed (If from partner)
This indicates whether it is a defrosted cycle or a fresh cycle.

 

44.

Origin of Sperm, If partner ejaculated/surgical retrieved
This is indicated in the Productie methode of the Sperma analyse of the partner or donor.

 

45.

Origin of Sperm, If from donor
This needs to be filled in manually.

 

46.

2 pn IVF.
The number of 2PN zygotes obtained from IVF.

 

47.

2pn ICSI
The number of 2PN zygotes obtained from ICSI.

 

48.

Frozen 2 pn
Het aantal ingevroren 2pn zygotes.

 

49.

Frozen cleaved
The number of frozen 2pn zygotes.

 

50.

Frozen blastocyst
These are the blastocysts that have been frozen.

 

Thawed Cycles

This data is extracted from the cell phase of the Frozen Embryo transfer event.

image-20250110-141124.png

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51.

No. 2pn thawed
These are the number of thawed 2pn embryos.

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52.

No cleaved thawed
These are the number of thawed cleaved embryos.

53.

No of blastocyst thawed
These are the numbers of thawed blastocysts.

Transfer

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54.

Transfer
This indicates whether a transfer has taken place or not.
This is entered in Laboratorium gegevens (Embryo transfer event)

  1. Transfer

  2. No transfer

  3. Transfer into surrogate

 

image-20250110-141405.png

 

 

image-20250110-141411.png

 

55.

Cause of no transfer:
If one (or more) of the options is completed in the Treatment Plan tab, it will be checked:

  • No mature oocyte

  • No sperm

  • No transferable embryo available

  • OHSS risk

  • Other reason

If there is no transfer, the following fields must be completed:

  1. embryos transferred

  2. PGD / PGS

  3. / 70. Complications

The rest of the fields no longer need to be filled in.

56.

57.

58.

59.

60.

Transfer date
This is collected from the Laboratorium gegevens.

61.

# embryos transferred
These are the number of embryos that have been transferred.

 

62.

PGD / PGS
If a PGD or PGS lab event has been performed, a Yes will appear here.

  1. Yes

  2. No

 

63.

Transfer outcome
This must be completed in the behandelingsplan tab of the treatment cycle.

If this is not filled in, IDEAS will retrieve the information from the Zwangerschapresultaat.
If both are not filled in, "Loss to follow up" is displayed.

  1. HCG detected (Pregnancy)

  2. No HCG detected

  3. Loss of follow-up

 

image-20250110-141710.png

 

Outcome tab

image-20250110-142552.png

The number of baby sections depends on what has been filled in 6. # children born.

Complications

image-20250110-142642.png

This is retrieved from the Treatment Plan tab of the Treatment Cycles.

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64.

Complications
If there is a complication, it is checked:

  • OHSS

  • Severe

  • Infection (PID)

  • Bleeding

  • Thrombosis

  • Death

  • Other

 

image-20250110-142720.png

 

 

 

 

65.

66.

67.

68.

69.

70.

Pregnancy outcome

 

image-20250110-142808.png

In the outcome tab, everything is entered after a positive outcome.

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  1.  

Cycle identification (Zie 1. Cycle identification)
This is the BELRAP code of this cycle

This is automatically fille in by IDEAS.

  1.  

Highest # intra-uterine FHR on ultrasound scan before 20 weeks
This is retrieved from Ultrasound:

image-20250110-142929.png

  1.  

Embryos reduction
This comes from the result of the fetus during the Ultrasound:

 

  1.  

Pregnancy outcome
This is taken from the  Zwangerschapsresultaat.

  1. Biochemical pregnancy

  2. Ectopic pregnancy

  3. Miscarriage before 20 weeks

  4. Induced abortion

  5. Molar pregnancy

  6. Delivery

  7. Loss of follow-up

 

image-20250110-143038.png

 

  1.  

Date of delivery or end of pregnancy
This is taken from the  Zwangerschapsresultaat.

  1.  

# children born
This is taken from the  Zwangerschapsresultaat.
In BELRAP 4 babies can be entered.

If the number of babies has been entered, the same number of sections with the questions for the babies will appear.

Baby 1 t/m 4

image-20250110-143616.png

If no children have been born the fields will be empty.

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7-11-15-19. Birth weight child
Birth weight in grams (0-10000).
If the birth weight is unknown, enter "0".

 

image-20250110-143439.png

 

8.

8-12-16-20. Sex of child

  1. Male

  2. Female

  3. Unknown

9.

9-13-17-21. Is the child still born?
If Still birth is selected for the Outcome, it will be entered here.

  1. Yes

  2. No

  3. Unknown

10.

10-14-18-22. Has child a malformation
This is entered under Geboorte afwijking.

  1. Yes

  2. No

  3. Unknown

 

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