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 all patients follow 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 three consultants Stephen Keay, Rina Agrawal and Tarek Ghobara. Referrals are made by either your General Practitioner, Advanced Nurse 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, therefore it is ideal for you both to attend this appointment. 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 to one year they do not normally need to be repeated.
We will initially take a full history from both partners, so it is advisable for you both to attend. 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 vaginal 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 so that we do not waste valuable time. 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.
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 in a 28 days 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). An important indicator of ovarian reserve is a blood test called Anti Mullerian Hormone which is a very sensitive marker of ovarian reserve. Unfortunately the NHS does not fund this test and therefore this blood test is chargeable.
Anti-Mullerian Hormone (AMH) is produced by small follicles (pouches which contain the eggs) growing in the ovary. It can be measured in a blood test. The level of AMH reflects how many follicles are growing, which gives an indication of how many eggs are present in the ovary. The number of eggs present in the ovary declines as we age, until the menopause, when the supply runs out. The more follicles that are growing, the higher the level of AMH in the blood. We can use this AMH measurement to predict how strongly the ovaries will respond to the hormones used in an IVF cycle.
For more information about Anti-Mullerian Hormone (AMH) testing please click here.
A vaginal ultrasound scan is often carried out at the first appointment and provides important 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 ovarian cysts such as caused by endometriosis or whether there are any fibroids affecting the uterus.
The Fallopian tube is where fertilisation of the egg and sperm takes place. If the tube is blocked or damaged the egg and the sperm cannot meet and fertilisation cannot 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. Possible investigations include HyCoSy and/or Laparoscopy (see below).
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 but does cause pelvic discomfort and is performed as an outpatient 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 key-hole 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. 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 treatment 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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