F.A.Q

Welcome to our "Frequently Asked Questions"

Anti-mullerian hormone (AMH)

Anti-mullerian hormone (AMH) is used in conjunction with menstrual FSH to give a guide to a woman’s ovarian reserve when assessing their fertility potential.

It is produced by the granulosa cells in the small ovarian follicles, the highest amount being produced when the follicles are less than 4mm in diameter. Production of the hormone ceases once the follicles reach 8mm.

With increasing female age, the size of their pool of remaining microscopic follicles decreases. Likewise, their blood AMH levels and the number of ovarian antral follicles visible on ultrasound also decreases.

Women with many small follicles, such as those with polycystic ovaries have high AMH hormone values and women that have few remaining follicles and those that are close to menopause have low anti-Mullerian hormone levels.

The amount of follicles remaining in her ovaries is referred to as “ovarian reserve”.

Unfortunately even if a blood test indicates that the woman has a high level of dormant follicle this does not necessarily mean that the eggs will be of a high quality. Patients with high AMH results tend to respond better to ovulation stimulation for IVF therefore giving us a greater pool of eggs to fertilise which in turn leads to higher pregnancy rates.

However a low AMH does not mean poor egg quality and even if there are fewer eggs, pregnancy can still result.

Fertility Clinics can carry out an AMH blood test, if necessary, as part of their investigations prior to undergoing IVF to give some information about the likely response to medication. In many cases however, the ovarian appearance and menstrual FSH give sufficient reassurance about likely response to therapy.

As there are follicles of varying maturity in the ovaries it means that the AMH test can be done on any day of the menstrual cycle as the levels do not fluctuate.

The test is expensive (£50 per test) and the samples are sent to Glasgow for analysis taking up to 4 weeks for results.

For this reason fertility clinics do not recommend that GP’s routinely undertake this test.

When an FSH taken in primary care is raised and the comment ‘Recommend prompt referral to the fertility services’, they may undertake an AMH at your consultation.

Donors and Surrogates

Donors are asked to consent to the use and storage of their donated material, but have the right to change their mind and withdraw from donation at any stage up until embryo transfer or insemination.

Although treatment must be carried out by HFEA-licensed fertility clinics, they are not permitted to recruit surrogate mothers on your behalf, so you must find your own.

Contacting these organisations COTS (Childlessness Overcome through Surrogacy) or Surrogacy UK would be a good starting point for advice on how to do this.

Providing the donation is through an HFEA licensed clinic, the person donating will not be the legal parent of any child born, and will have no obligations to or rights over that child. Recipients of donations will become the legal parents.

When fertility treatments involve the use of donor sperm, eggs or embryos, fertility clinics are required to collect and pass on information about the donor, recipient and treatment cycle to the HFEA, for its confidential register.

The purpose of this register is to allow people conceived through donation to find out who the donor was, once they reach 18. The identity of the donor is not released to the recipient(s).

Egg Collection

The number of eggs that are collected per cycle can be variable, depending on your age and medical history but they aim to obtain 10 – 12 per egg collection.

Pre-egg collection it is fine to take moderate exercise.

Post-egg collection you should ease off and avoid swimming, but walking is excellent for you to do.

Any form of exercise that causes breathlessness should be avoided in the run up to egg collection and immediately afterwards.

It is fine to continue to have a normal sex life during the process.

The egg collection takes 10 – 15 minutes and you will be given adequate pain relief and sedation.

Temporary amnesia is quite common afterwards as a result of the sedation.

Embryo(s) Transfer

Yes, it is fine to take hay fever medication.

Yes, you may take simple pain relief post procedure. It is also alright to take before treatment. It is advised only taking paracetamol though.

No, you will not require a doctor’s note whilst undergoing treatment.


However, some parents feel that for “piece of mind” sake that taking leave or getting signed off for two weeks after transfer gives the embryo the best chance of success by being able to relax and be stress free while the embryo implants itself in the womb.

The clinic can’t recommend this as an option because there is no scientific basis, but a lot of successful parents believe this helped.

No, sedation is not required for the transfer.

All embryos are graded on a daily basis which helps select those that are making the best progress and therefore more likely to result in a pregnancy.

Clinics normally aim for a single embryo transfer but older patients or those having more difficulty will be permitted two embryos.

Occasionally they can transfer three embryos (the maximum permitted) in women over the age of 39.

Depending on how you are feeling emotionally it is possible to start treatment again on your following menstrual cycle but if you wish to wait for a period of time that is perfectly acceptable.

Pre-egg collection it is fine to take moderate exercise.

Post-egg collection you should ease off and avoid swimming, but walking is excellent for you to do.

Any form of exercise that causes breathlessness should be avoided in the run up to egg collection and immediately afterwards.

It is fine to continue to have a normal sex life during the process.

Transfer takes place 2 – 5 days after egg collection.

Female Fertility

Remember that some symptoms like breast tenderness, bloating, tiredness and upset stomach can be caused by the drugs you are taking. You can’t really depend on your body to tell you if you are pregnant or not, so you need to wait for the test.

Try not to worry about cramps and twinges – many women get these and they do not affect the chances of implantation.

Check with your clinic what system they use.

Our clinic used a state-of-the art electronic witnessing system to ensure this.

They confirm a person’s identity with them when eggs or sperm are first collected and each dish or tube is labelled with that person’s name, date of birth and clinic number, together with an electronic witnessing tag.

The RI Witness system then monitors every instance when sperm, eggs or embryos are transferred from one container to the next and ensures that only one patient’s samples can be worked on at a time.

If they were to try and place samples from different patients in the same work area a loud alarm would sound.

At embryo transfer the embryologist asks the patient to confirm her identity and check her own Witness ID card, which is electronically matched to the dish containing the embryo(s) for transfer. The culture dish lid is also double-checked by the nurse performing the embryo transfer.

For most patients the uterus is measured at egg collection and the transfer catheter is adjusted accordingly for each individual. Occasionally it is not possible to obtain a uterine measurement and in these cases we use a default setting of average uterine size.

Embryos are tiny at this stage (about a tenth of a millimetre) and during embryo transfer they settle down into one of the small crevices in the endometrium (lining of the uterus).

Embryos do not fall out when you stand up and research has shown that bed rest following embryo transfer makes no difference to the chances of pregnancy.

The embryo(s) continue to grow and hopefully will implant in a few days’ time (about 7 days after egg collection).

If you are in your late 30’s or early 40’s and want to have a child, successful conception over the age of 40 is still very possible. However, women over 40 have fewer eggs in their ovaries. This means that the number of their eggs, and embryos after fertilization tend to be reduced.

For 23 years specialists have successfully treated many women aged 40 and above who wish to have a family, as consistently excellent success rates show.

Age-related Infertility and Donor Eggs

Age-related infertility is often associated with older maternal age, when the ovaries’ store of eggs is beginning to run out. IVF with Donor Eggs maybe a good option if you have age-related infertility. Egg donors are much younger which increases the chances of pregnancy significantly.

If you decide to use Donor Eggs, your treatment cycles are carefully timed so the donor’s eggs are ready when you are. The donor’s eggs are then fertilised with your partner’s sperm and the resulting embryo(s) transferred into your uterus.

Caution is advised attempting IVF over 43 years of age because of the low chances of success with your own eggs. Use of donor eggs gives a much more realistic chance of having a baby.

Whilst waiting for treatment to begin many couples want to know if there is anything they can do to improve their chances.

A healthy lifestyle, well-balanced diet, stopping smoking and reducing alcohol consumption may all help.

Women should also be taking folic acid supplements.

It is advised that it is best to freeze your eggs before the age of 38 and preferably earlier.

Egg freeze cycle, IVF including egg vitrification (freezing) and first year storage £2,400

Annual storage charge for eggs                                   £  230

Drugs (varies £800 – £1700) average cost            £1,200

Total cost                                                                                  £3,830

 

Later fertilization (ICSI required)                                  £800

All eggs will usually be fertilized and embryos cultured to select best one or two remaining good embryos frozen and stored £500

If you have a positive pregnancy test you must continue to use your luteal support drugs daily. You will need to contact the clinic to arrange collection of more luteal support drugs and to make an ultrasound scan appointment for 2 – 3 weeks time.

At this stage it is best to be cautiously optimistic; miscarriages may occur at any stage in pregnancy, although they are much less common after 12 weeks.

For those couples where pregnancy does occur you will need to contact your GP to arrange antenatal care.

Helpful advice about eating, drinking and exercise in early pregnancy can be found on the website www.nhs.uk/conditions/pregnancy-and-baby.

You should rest and take things easy.

Unfortunately at this stage this is all that can be done, and you need to wait and hope for things to settle.

It is still possible for a pregnancy to continue despite some bleeding so you shouldn’t lose hope at this stage. If you start bleeding at night please contact your clinics nursing team the next working day.

Although bleeding can be very distressing it is not a medical emergency, so please do not call the clinics emergency number.

You can carry out a pregnancy test 2 weeks after the date of your embryo transfer.

Some patients start to bleed before they are due to test, however you should still continue with your medication and test on the recommended day.

If you have been drinking large quantities of fluid (more than 2 litres per day) it is possible that your urine may be too weak for a positive result to show, so if you have not had a period 2 days later you should carry out another test. By this time the result will be definite, whether positive or negative (if after this time the result remains negative you should stop taking the luteal support drugs).

If you are uncertain about the result please do not hesitate to ring your clinic.

If you are not pregnant you should stop taking the luteal support drugs (you should then have a period in the next few days).

If you are pregnant you need to continue with the luteal support until your second scan (approx 9 weeks).

If you have had a frozen embryo transfer with down-regulation you will need to continue with your progesterone and oestradiol until 12 weeks of pregnancy.

Finance Package & Cost

You will need to either contact your nearest Fertility Clinic or alternatively check with your GP surgery on whether you are eligible for NHS funding and how many cycles are covered as this will vary from CCG (clinical commissioning group).

If you are not eligible for NHS funding then the clinic will be able to give you a comprehensive self-funding price list which shows exactly what will be covered in each treatment.

Yes. Most Fertility Clinics offer finance packages. Depending on what the clinic offers you could get a prepay multi-cycle plan (2 cycles) at lower cost than paying for each cycle individually. There may also be an IVF refund package, (3 cycles) where eligible patients receive up to a 100% refund if you do not have a baby.

Both plans offer a significant saving compared to paying for treatment as you go if you end up needing more than one cycle to achieve a pregnancy. So its worth checking out different clinics and comparing what they offer!

It is advised that it is best to freeze your eggs before the age of 38 and preferably earlier.

Egg freeze cycle, IVF including egg vitrification (freezing) and first year storage £2,400

Annual storage charge for eggs                                   £  230

Drugs (varies £800 – £1700) average cost            £1,200

Total cost                                                                                  £3,830

 

Later fertilization (ICSI required)                                  £800

All eggs will usually be fertilized and embryos cultured to select best one or two remaining good embryos frozen and stored £500

A previous vasectomy or failed reversal means you have no sperm to ejaculate. Your treatment would involve the surgical sperm recovery.

IVF with ICSI (includes embryo transfer)  £4,550

Surgical sperm removal (PESA/TESA)      £1,850

Embryo storage                                                     £   500

Drugs (varies £800 – £1700)                          £1,200

Total                                                                              £8,100

 

* Prices will vary by clinic, the prices above were correct at the time of writing.

It varies between fertility clinics so check the paperwork, but usually you will be invoiced 2 weeks before the start of your treatment cycle and payment is due before treatment can begin.

General Fertility

It is understandable that you may be worried about the Zika virus .

Please see here for further advice.

Yes, most clinics offer an egg freezing service for patients who have either a personal or medical reason for requiring this treatment.

Some clinics even offer the latest vitrification technique.

It is not possible to return unused drugs to the fertility clinic, however, you can take unused drugs to local pharmacies like BOOTS who will dispose of them for you.

They DO NOT provide refunds!

If you have any used/unused needles you need to call your local government customer services and arrange for a collection. They must be safely secured in a sharps bin prior to collection (the clinic usually provides a bin with the injections but you may need to ask!)

Most Fertility Clinics believe that everyone should have the opportunity to become a parent and regularly treat single women and same sex couples.

Self-funded patients are able to refer themselves directly to a Fertility Clinic but it is always recommend asking your GP for a referral letter as they are able to furnish the clinic with a detailed medical history which they are not able to access otherwise.

You will need to be referred by your GP if you are wishing to be seen as an NHS patient.

Although there are no holistic therapies that clinics recommend, they would not advise against them as they feel that is very much a personal preference.

There is no indication that these therapies affect the success rates of IVF.

They however, do not recommend Chinese medicine as its effects on IVF have not been validated and the treatments are often unregulated.

A good clinic will hold regular open evenings which are free to attend.

You will have a opportunity to look around the clinic, meet the staff and have at least ten minutes one-on-one discussion about your particular concerns and the chance to ask any questions you may have.

  1. Most Clinics have an open evening that you can go and look at the facilities, ask questions and meet the team before making up your mind.
  2. Check their website/Facebook page at the comments – especially from former patients to see if they were happy with their experience.
  3. Ask if they do satisfaction surveys and ask to see the results. Proper surveys include patients that have had successful and not successful outcomes, so you get a balanced view.
  4. If you have any questions, a good clinic, will have no problem with you phoning them and answering any questions you may have.

 

There is a short waiting time from calling to make your appointment to seeing a doctor.

You will then normally start your treatment on your next cycle although in some cases, depending on timing, you may be able to start treatment immediately.

It is usually recommended that a couple actively try for a family for 12 months before seeking advice or referral from their GP. If there are known factors that could be causing difficulty conceiving or if the female is in the older age range it may be sensible to visit their GP earlier.

Depending on who you work for it can be difficult to fit IVF treatment in with your work commitments. Some employers are more sympathetic than others and unfortunately IVF is still classed as voluntary procedure and is often not covered by your companies policies.

As a general guide:

  1. The initial consultation usually takes one hour which includes a scan.
  2. When you actually start your treatment there will be a minimum of two further scans each of which you should allow about half an hour.
  3. For egg collection you will need a whole day off work as you will be receiving sedation, and if possible you might like the following day off too.
  4. For embryo transfer you will need to be at the clinic for an hour and should take half a day off work.
  5. If you can/feel you need to for piece of mind, get 2 weeks off once the egg/s are transferred so that you can relax and be away from any stress. Ether by taking holiday or see if your GP will sign you off if you work in a stressful environment.

As with any medical procedures, there are associated risks. These will be explained to you by your consultant and you will be given information to take home.

Complications are infrequent but you will be advised of the small risk of Hyper-stimulation associated with IVF.

Please click here to see information from The Royal College of Obstetricians and Gynecologists.

Having a serious cold/infection during or before your treatment should not affect your treatment plan. If you have any concerns please speak to one of the nurses at your clinic.

If you have flu, with significant rise in temperature, this can compromise an IVF cycle for both partners.

When flu is prevalent you may wish to consider getting a flu vaccination.

Intracytoplasmic sperm injection (ICSI, pronounced /ɪksiː/, IK-see) is an in vitro fertilization (IVF) procedure in which a single sperm is injected directly into an egg.

Defective sperm function remains the single most important cause of human infertility. Although certain severe forms of male infertility have a genetic origin, others may be the result of environmental factors.

During the past decade, ICSI has been applied increasingly around the world to alleviate problems of severe male infertility in human patients who either could not be assisted by conventional IVF procedures or could not be accepted for IVF because too few motile and morphologically normal sperm were present in the ejaculate of the male partner.

In vitro fertilisation (or fertilization; IVF) is a process of fertilisation where an egg is combined with sperm outside the body, in vitro (“in glass”).

The process involves monitoring and stimulating a woman’s ovulatory process, removing an ovum or ova (egg or eggs) from the woman’s ovaries and letting sperm fertilise them in a liquid in a laboratory. The fertilised egg (zygote) undergoes embryo culture for 2–6 days, and is then transferred to the same or another woman’s uterus, with the intention of establishing a successful pregnancy.

IVF is a type of assisted reproductive technology used for infertility treatment and gestational surrogacy, in which a fertilised egg is implanted into a surrogate’s uterus, and the resulting child is genetically unrelated to the surrogate. Restrictions on availability of IVF include costs and age to carry a healthy pregnancy to term. IVF is mostly attempted if less invasive or expensive options have failed or are unlikely to work.

For NHS funded treatment it depends on the local CCG, Current guidelines say an ideal BMI would be between 18 – 30 .

However, for privately funded treatment most clinics do not have any restrictions and would be dealt with case by case.

Male Fertility

There are various things that you can do to help increase your sperm count. The main two are to give up smoking and cut back on your alcohol intake. Avoid drugs such as marijuana, and other recreational drugs, as these can affect the quality of your sperm and decrease your sperm count.

Use of anabolic steroids is always detrimental to sperm production, and the use of “supplements”, “protein shakes” etc for body building is not always safe, as they are not always “clean”.

You may also take some vitamin and mineral supplements , the main ones being Vitamin C & Vitamin E and Selenium and Zinc. There are a number of proprietary preparations containing these ingredients plus others, which can be helpful.

Frequency of intercourse is also important – essentially there is no upper limit. Regular intercourse is essential for two reasons: firstly to make sure that sperm and egg meet during the short fertile “window”; secondly the quality of sperm improves with regular frequent ejaculation.

Maintaining a healthy body weight and eating well will also help. You may also take some vitamin and mineral supplements such as Vitamin C & E and Zinc as this may help some men improve the quality of their sperm.

Many couples find assisted conception treatments stressful.

Therefore clinics would not wish to add to this by imposing any restrictions on your current lifestyle.

The only important point to mention is the length of abstinence from sexual activity. “Saving yourself” for too long before egg collection is not a good idea!

Whilst a very short space of time (e.g. one day) between samples can decrease the sperm count, it is important to realize that too long a period of abstinence can decrease sperm motility (the percentage of sperm actually swimming). Sperm are made continually and if they are not produced regularly (a couple of times a week) this may result in a backlog of poor quality sperm.

Yes, it is possible for you to freeze your sperm.

There will be an annual storage charge which you will need to check with individual clinics for pricing.

Fertility Clinics have helped many men become fathers and can offer the latest advanced procedures including Sperm DNA fragmentation, hormone tests, genetic or chromosomal analysis or surgical retrieval of sperm and chromosomal tests.

We appreciate how stressful it must be when you know that you have to produce a sperm sample on the day of IVF.

It is possible for the clinic to provide you with Viagra if necessary.

Although it is very rare for the partner to be unable to produce the semen to fertilize the eggs on the day of egg retrieval it does sometimes happen. In this case it is possible to perform a surgical sperm retrieval.

Usually the process will change from IVF to ICSI as there will be a smaller amount of sperm for egg fertilization.

The other alternative is to freeze the collected eggs and fertilize at a later date.

Some clinics offer the use of Sildenafil (Viagra) if needed, and sometimes it may be appropriate to allow sperm production at home.

Up to 20% of men in the UK have either a low sperm count or poor quality sperm so it is far more common than most people assume.

While women may talk about their fertility issues in quite an open manner, men often feel that they can’t discuss their low sperm count in the same way, as many people mistakenly think that this is linked to a man’s virility which is incorrect.

Of the couples who seek medical help to achieve a pregnancy – in one third of cases this will be due to male factor infertility.

Many men find it helpful to be able to discuss their fertility problems with a professional counselor.

A previous vasectomy or failed reversal means you have no sperm to ejaculate. Your treatment would involve the surgical sperm recovery.

IVF with ICSI (includes embryo transfer)  £4,550

Surgical sperm removal (PESA/TESA)      £1,850

Embryo storage                                                     £   500

Drugs (varies £800 – £1700)                          £1,200

Total                                                                              £8,100

 

* Prices will vary by clinic, the prices above were correct at the time of writing.

Your fertility will start to diminish from approximately age 40 but you will not be affected in the same way as a woman, whose fertility starts to decline from their early thirties and who is unlikely to become a mother after her mid-forties.

The majority of men are able to become fathers in their 50’s and beyond without any issue.

It has been shown that drinking excessive amounts of alcohol can affect the quality of your sperm. Government guidelines suggest that you should spread your alcohol intake over a three days or more rather than binge drink and that ideally you should not exceed 14 units per week.

Binge drinking i.e. a stag weekend are notorious for damaging sperm supply for a period of time.

If you smoke you risk reducing the quality and amount of sperm but if you give up smoking this effects are reversible.

Treatments

Yes, NHS patients are able to have these extra treatments.

However they are not covered by the NHS contracts with the CCGs and if you would like them there will be a supplementary charge.

Most fertility clinics don’t offer Lite IVF. You will need to check with your local clinic to see if they offer it.

Clinics don’t currently offer intralipid infusions.

The Royal College of Obstetricians and Gynaecologists has recently issued guidance warning of the risks of this untested therapy.

A blastocyst is an embryo that is 5 or 6 days old. It looks like a hollow sphere and has 2 cell types, the cells around the surface of the sphere (‘trophectoderm‘) which form the placenta, and an inner ball of cells, the ‘inner cell mass‘ which forms the fetus.

Why culture blastocysts?

Not all embyros reach the blastocyst stage.

Embryos that develop as far as the blastocyst stage are fitter and stronger and so have more chance of implanting after transfer. The timing of the blastocyst transfer mimics natural conception, as embryos are transferred at the time they would normally reach the uterus, hence uterine conditions at this time are ideal for the embryos.

Who is suitable for blastocyst culture?

Blastocyst culture is suitable only for some fertility patients, and depends on the number and quality of your embryos.

Many embryos may not continue developing for five days and our experience has shown that only about half of embryos are capable of development into blastocysts in the laboratory.

Embryos are assessed daily to see if there are sufficient top quality embryos to be able to progress with blastocyst transfer. If not, embryo transfer is carried out on day 2 or 3.

Any excess good quality blastocysts remaining after transfer can be frozen.

Endometrial scratching is a relatively new technique to try and improve endometrial receptivity, helping embryo(s) to implant.

Once your embryo(s) are transferred into your uterus the embryo needs to hatch out of its surrounding protective membrane called the zona pellucida, in order to be able to implant into your uterus. This happens when it reaches the blastocyst stage at 5 – 6 days old.

There is evidence to suggest that this hatching process may be a problem for some patients’ embryos, where a thickened or hardened zona may not allow it to occur.

Laser Assisted hatching is a laboratory technique, where a small slit is made in the soft membrane of the embryo shortly before embryo transfer. When the embryo reaches the blastocyst stage, this gap then allows the embryo to emerge (hatch) which may help it implant and establish a pregnancy.

Who is laser assisted hatching suitable for?

Most patients do not need assisted hatching. Studies indicate there may be improved implantation and pregnancy rates if the following applies to you:

  • You have failed to conceive following three or more IVF / ICSI cycles
  • If the zona pellucida of your embryo(s) appears thicker than normal

Assisted hatching is a delicate technique requiring specialist equipment and skill, so there is an additional charge for this procedure.

Time-lapse monitoring is used to help identify the strongest embryos for transfer.

The Primo-Vision system uses five cameras to monitor the incubators in the laboratory, and these are booked on a first-come, first-served basis.

There is a charge for this additional monitoring technique.

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