Considering fertility treatment is an important and sometimes difficult process and you will have questions about the journey you may be about to take. This section should help address some of your concerns. However, it is important to remember that not everyone follows the same pathway and we, at the Centre for Reproductive Medicine (CRM), believe your treatment should be tailored to your individual requirements. We are always happy to speak to you directly if you have any other questions you would like to raise. Click here for contact details
Patients are referred to The Centre for Reproductive Medicine's Team, initially to one of our four consultants Richard Kennedy, Stephen Keay, Rina Agrawal and Tarek Ghobara. Referrals are made by either your general practitioner or your hospital consultant. On receipt of the referral, an appointment will be sent to you or arranged through the Choose and Book service. The appointment should be within four weeks of receipt of your referral letter.
If this is your first appointment at the CRM, you will be asked to have some preliminary tests before attending the clinic. These will include a blood test to measure your progesterone level (ovulation test), an assessment of your Rubella immunity (German Measles) and a semen analysis (sperm test). If you have already had these tests done within the last six months they do not normally need to be repeated.
We will initially take a full history from both partners. For the woman, this will include your general health, gynaecological details and any previous pregnancies and their outcomes. The doctor or nurse in clinic may want to perform an examination which may include a transvaginal (internal) scan and swabs. Any further investigations that a couple may need to investigate their fertility will be arranged. The most suitable treatment options will be discussed and, if you wish to proceed, arrangements will be made.
It is almost always necessary for the male partner to undertake a sperm test and it is most helpful if this is carried out well in advance of your consultation. This information is then available to be discussed with you at your visit.
If you have had tests or treatment carried out elsewhere please bring details with you if possible.
If you have had no tests carried out, and this is your first attendance at an infertility clinic, you may be seen first by one of our experienced Infertility Nurse Specialists who will assess you, give you appropriate advice and arrange the necessary tests before you see the doctor.
We will assess whether the woman is ovulating and this is done by taking a blood sample and measuring Progesterone - normally on the 21st day of the menstrual cycle. Ideally this test should have been arranged by your GP before you attend the CRM.
We will arrange other hormone tests such as FSH, LH, Prolactin and Thyroid tests if indicated. FSH is helpful in assessing how active the ovaries are and the ovarian reserve (number of eggs available).
A vaginal ultrasound scan is often carried out at the first appointment and provides useful information about the shape of the uterus (womb), the health of the lining of the uterus and the ovaries. In particular it can tell us whether the ovaries are polycystic, whether there are any large cysts such as may be caused by endometriosis or whether there are any fibroids affecting the uterus.
The Fallopian tube is where fertilisation occurs. If the tube is blocked or damaged the egg and the sperm cannot meet and fertilisation will not take place. Tests are often needed to assess whether there is a blockage in the tube. Your gynaecological and medical history will determine which investigation is most appropriate for you. These are the options.
HyCoSy procedure involves passing a fine catheter into the uterus and injecting a dye. If the dye passes through the Fallopian tubes this can normally be seen on a transvaginal ultrasound scan. This procedure does not require an anaesthetic.
This is an x-ray of the Fallopian tubes and uterus. It is performed in the x-ray department and does not require a general anaesthetic. A radio-opaque dye is passed through the cervix into the uterine cavity. The dye shows on the x-ray and the doctor is able to see if the dye flows out of both Fallopian tubes into the abdominal cavity. This is similar to a HyCoSy procedure.
This is an operation carried out under general anaesthetic, usually as a day case. A slim telescope, called a laparoscope, is inserted through a small incision made in the umbilicus (tummy button) to enable the doctor to see the uterus, Fallopian tubes and ovaries. Dye is injected into the uterus via the cervix to test for any tubal blockage. If the tubes are healthy the dye will pass through. Although this test gives the most information it is more invasive and carries infrequent, but nevertheless, important risks.
If the male partner has any related symptoms, or if there is a problem with the semen analysis (sperm test), it may be necessary to undertake a physical examination. This is usually undertaken in the Male Infertility Clinic by a urologist.
You will be asked to arrange an appointment to produce a semen sample. It is usual for us to request more than one sample. We will measure the volume and number of sperm produced, the percentage of sperm which are motile (moving), the percentage of abnormally shaped sperm and check for signs of infection. The results of these tests will help to identify if there is a sperm problem needing treatment.
If there is a severe problem with the sperm, blood tests may be undertaken to assess certain hormone levels and the man's chromosome status (genetics).
An ultrasound scan may occasionally be required by the Urologist to look at the male glands that form part of the reproductive system. This is a specialist examination known as a 'TRUSS' test.
Once we have enough information from the tests to understand the cause of your infertility, we will recommend the treatment most appropriate to your requirements. It is not possible to describe all possible eventualities but the following are broadly what may be offered:
a) If the woman is not ovulating this can be corrected by the use of drugs and the monitoring of response by ultrasound. This is known as ovulation induction. Sometimes these methods are combined with intra-uterine insemination (IUI).
b) If there is a blockage or scar tissue around the Fallopian tubes, or another important indicator of female infertility, IVF is usually offered, however, tubal surgery may be appropriate in carefully selected cases.
c) If there is significant endometriosis we may offer treatment for this or discuss the use of treatments such as IVF or IUI.
d) If there is a major concern about the numbers or quality of sperm we may discuss IVF with ICSI, Surgical Sperm Retrieval or the use of Donor Sperm.
e) If the infertility problem is unexplained we may advise that a naturally conceived pregnancy is still very likely to occur or that some help should be given such as IUI or IVF treatment.
f) Various other treatment options and combinations may be offered where appropriate depending upon your individual circumstances.
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