Patient Information. An important step in getting pregnant is making sure you are healthy, which you can do by making some simple lifestyle changes.

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1 Gynae Out Patients Department Fertility Service Patient Information PRE-CONCEPTUAL ADVICE An important step in getting pregnant is making sure you are healthy, which you can do by making some simple lifestyle changes. Diet Make sure you eat a nutritious, balanced diet, containing plenty of fruit and vegetables, carbohydrates such as wholemeal bread and pasta, and lean meat, fish, and pulses for protein. Women who are either under or overweight, ovulate (release an egg) less regularly and sometimes not at all. Ensuring you maintain a healthy weight will therefore make it much easier to conceive. Folic acid It is recommended that women trying to conceive should take 400 mcg daily folic acid supplements. This helps to protect the unborn baby from problems such as spinal bifida (when the baby's spine does not develop properly). Lifestyle It is very important to stop smoking if you are planning on getting pregnant. Smoking is linked to infertility and early menopause in women, and has been showed to reduce sperm quality in men. Taking regular exercise helps you to maintain a healthy weight and beat stress. The Department of Health recommends that women drink no alcohol while trying to conceive, as studies have shown that it can seriously damage a baby's development. If you do decide to drink during your pregnancy, limit your intake to one or two units of alcohol, once or twice a week, and avoid getting drunk. Alcohol may also affect sperm quality. Illegal drugs, such as marijuana or cocaine, should be completely avoided.

2 INVESTIGATIONS This is a list of the investigations you will be offered that the doctor or nurse will explain: Blood (Hormonal) tests: Blood tests are timed according to your menstrual cycle. The first day of your period is counted as Day 1. Please do the following blood tests between Day 2 to Day 4 of your cycle FSH, LH, E2. (Follicle Stimulating Hormone, Leutinising Hormone, Estradiol) If you have been asked to have a day 21 progesterone blood test (counting the first day of your period as Day 1) remembering that if this falls at the weekend, have this done on Friday or Monday. If your periods are longer or shorter than 28 days, the doctor will tell you when to do them. This test is to look for ovulation or response to ovulation inducing drugs. It is helpful to write down in your diary the date of your last menstrual period when you are doing the tests. Please phone the Fertility Nurse Specialist on: approximately two days after your Day 21 blood test for the results. Please only call between: Monday Thursday 9am -5pm and Friday 9am -2pm. The nursing staff will return your call at their earliest convenience. All other investigation results will be discussed with you at your next clinic appointment. You need to have your blood tests done in one of the hospitals within our group, otherwise we will not get the results i.e Broomfield, St Michaels or St Peters. The walk in service at Broomfield is open Monday Friday from 07:00am to 16:45pm. Blood tests can be pre-booked at Broomfield on: Blood tests can also be done at Christchurch Reform Church at 164, New London Road, Monday Friday, 07:00am to 15:45pm. These appointments must booked on the above number. Transvaginal Scan: Transvaginal ultrasound is a type of pelvic scan. This is done in order to give the doctor information about your reproductive organs like the womb, neck of the womb, ovaries and vagina. Transvaginal means inside the vagina, this is done using a probe. You will receive a letter in the post from the radiology department with a date and time for the test. If the transvaginal scan has been arranged by your GP and done elsewhere (other than Broomfield), the doctor will need a copy of the scan result.

3 Testing patency of the Fallopian tubes Hysterosalpingogram (HSG) Is an X-ray procedure to investigate the patency of the Fallopian tubes. The procedure requires the injection of dye into the cervical canal and womb and is done in the radiology department. The radiology department will contact you first. They will send you an information leaflet with instructions and a letter. This will tell you when to ring up the radiology department and arrange for the test. HyCosy: Hycosy is another procedure to check the patency of your Fallopian tubes. It is outpatient procedure which uses an ultrasound to look at the tubes instead of an x-ray. A small thin catheter (tube) is passed through the neck of the womb into your womb and a small balloon is inflated to keep the catheter in position. A vaginal ultrasound scan is carried out to locate the uterus and ovaries. Echo contrast fluid is inserted into the catheter and tubal patency is checked via the ultrasound scan. Once this has been established, the ultrasound scan and catheter are removed. To book appointment please calls Fertility Service on number on day 1 of your period. HSG or HyCoSy test need to be done within the first days after your period, which is known as the follicular phase of the cycle, as you are unlikely to be pregnant at this time. If you have irregular periods, the doctor will prescribe you hormonal tablets to take for 7 days. This will induce a period after which the test can be done. It is important that you do a pregnancy test if you are not having any periods, prior to taking any hormonal medication. You must use barrier methods of contraception during the cycle of the HSG appointment/ HyCoSy appointment. HSG and HyCoSy procedure can be painful, like bad period cramps. We advise you to take 1 gram of paracetamol an hour before your procedure starts to reduce the pain. We also advise you to take antibiotics for 5 days which you start on the morning of the procedure to reduce the risk of an infection. You will be given a prescription by the doctor in clinic, for the antibiotics, collect these from pharmacy at Broomfield and start these on the day of your test. Complications of the procedure are rare. These include infection and on the rare occasion, an allergic reactions to the materials used. If you suspect you have any signs and symptoms of infection please contact your G.P. and inform him/her that you had the test.

4 We advise you to take 1 gram of paracetamol an hour before your procedure starts to reduce the pain. We also advise you to take antibiotics for 5 days which you start on the morning of the procedure to reduce the risk of an infection. You will be given a prescription by the doctor in clinic, for the antibiotics, collect these from pharmacy at Broomfield and start these on the day of your test. It is advisable to bring someone with you to accompany you home. Laparoscopy: Sometimes the doctor will recommend having a laparoscopy and this allows the doctor the opportunity to look directly into your abdomen or pelvis, including the fallopian tubes, ovaries, uterus and other adjacent organs like the small bowel, large bowel, appendix, liver, and gallbladder. It may be necessary to rule out endometriosis if you are having heavy painful periods and also to look for the patency of the fallopian tubes amongst other indications. The doctor seeing you will explain why you need the surgery and what the risks and benefits are of the proposed procedure. You will be put on the waiting list for the surgery. You will receive separate letters and information sheets regarding this procedure. NOTES: SUMMARY OF INVESTIGATION Blood Test day 2-4 Blood Test day 21 Pelvic Scan awaiting letter HSG awaiting letter Laparoscopy awaiting letter MFT Blood Test SUMMARY OF INVESTIGATION Blood Test day 2-4 Blood Test day 21 Pelvic Scan awaiting letter HSG awaiting letter Laparoscopy awaiting letter MFT Blood Test

5 Contacts / Further Information Useful Contact Numbers: Fertility Service: Secretary: Please ask if you require this information in other languages, large print, easy read accessible information, audio/visual, signing, pictorial and change picture bank format via the Patient Advisory Liaison Service (PALS) on (01245) Mid Essex Hospital services NHS Trust is smoke-free. You cannot smoke on site. For advice on quitting, contact your GP or the NHS smoking helpline free, Document History Department Gynae Outpatients Department Published/Review: February 2013 / February 2016 File name Fertility Service Version/ref no 1.0 / MEHT130364