IVF & ICSI INFORMATION BOOKLET

Transcription

1 CENTRE FOR REPRODUCTION AND GYNAECOLOGY WALES ELY MEADOWS Rhodfa Marics Llantrisant CF72 8XL Tel. (01443) : Fax (01443) IVF & ICSI INFORMATION BOOKLET THE UNIT The Centre for Reproduction and Gynaecology Wales ( CRGW) has been established to provide a full range of investigations and treatment for couples experiencing infertility. It is housed in purpose built premises. We offer preliminary investigations, ovulation induction, secondary sperm function testing, intrauterine inseminations, donor sperm treatment, in vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI), assisted hatching, oöcyte donation, and freezing of sperm and embryos. The Centre is fully licensed by the Human Fertilisation and Embryology Authority and all work is carried out in accordance with the Human Fertilisation and Embryology Act and the Authority s Code of Practice. THE TEAM The team includes senior medical, nursing, scientific and secretarial staff that have many years of experience in infertility treatment. Our expertise and knowledge has been accumulated in some of the best Units in the UK. We, as a team, believe in providing the highest quality of treatment and care while understanding the anxieties and concerns of the couple. We offer a caring sensitive approach within a dedicated and knowledgeable team who appreciate the nature and problems of infertility, both physical and emotional. NATURAL CONCEPTION Every month an egg is released from the ovary and moves slowly down the Fallopian tubes (tubes) towards the uterus (womb). If sperm have been released in the vagina during intercourse within the previous day or two these may have swum up to the tubes where they attempt to combine with the egg. If this union is successful, the fertilised egg continues along its path to the womb growing along the way. After 5 days, the embryo (as it is now called) begins to implant in the lining of the uterus. If this implantation is successful and the embryo establishes itself well, a pregnancy will result. If no sperm were present, or they did not fertilise the egg, the egg will continue towards the womb, be expelled and a period will begin (two weeks after the egg was first released). WHAT IS IVF? In vitro fertilisation (IVF) is a phrase, which describes the process by which the oöcyte or egg is fertilised by the sperm outside the body. Originally, this was carried out in glass dishes, which is how the term in vitro arose, as this literally means in glass. IVF involves the collection of eggs and sperm, which are then mixed in the laboratory under strictly controlled conditions. The eggs, which fertilise normally, are left to grow for a further day or two to check that they are developing normally. In most women a maximum of two embryos are replaced in the womb (although the law allows us to replace up to three in patients over the age of P.I. 1.3-Assisted Conception Information Booklet-V:1 jan10 UA/AOL Page 1 of 11

2 40), and if there are remaining embryos, which are of suitable quality, they may be frozen. The frozen embryos can be thawed and replaced at a future time. WHAT IS ICSI? ICSI stands for intracytoplasmic sperm injection and is a technique used for male factor causes of infertility such as a very low sperm count. The process is very similar to that in IVF cases, but the difference is that a sperm is injected directly inside each egg. By placing the sperm inside the egg it gives an opportunity for fertilisation to occur where it is not possible naturally due to poor sperm quality. This is still a relatively new technique that has been used routinely in the UK since the early to mid 1990 s. There are a number of specific risks associated with ICSI, they are: (a) a reduced number of eggs being available for treatment (compared to IVF), due to eggs being immature or damaged by the process of ICSI. (b) children conceived having inherited genetic, epigenetic or chromosomal abnormalities (including cystic fibrosis gene mutations, imprinting disorders, sex chromosome defects and heritable sub-fertility). Genetic testing of the male partner is performed in cases where men s sperm count is low. WHO CAN BENEFIT FROM IVF AND ICSI? Couples having difficulty conceiving a child may be having a problem in any or several of the steps involved in natural conception. IVF and/or ICSI can help many couples including those in which the woman has blocked, damaged, or no fallopian tubes; the woman has the condition called endometriosis; the man has a reduced sperm count; the woman has problems ovulating or no cause of infertility has been found. PATIENTS WE TREAT We recommend that to increase your chances of a successful treatment that you are the right weight for your height. A measurement used to help assess if you are within a healthy range is called Body Mass Index (BMI). A member of our team can work this out for you. Excess weight may not only reduce your chance of success but in extreme cases is associated with a significant health risk to both mother and baby. When couples request treatment, we are by law required to take in to account the welfare of a future child. Our unit policy is to assess each couple individually. THE TREATMENT There are four main stages, which IVF requires. 1. The use of special hormones to stimulate the ovaries to produce more than one egg. 2. Collecting the eggs from the ovaries. This is usually performed under sedation. 3. Preparation of the sperm sample for mixing with the eggs on the day of egg collection. 4. Replacement of fertilised eggs (embryos) into the womb. During a natural cycle the ovary produces one and occasionally two eggs. For IVF the production of a greater number of eggs increases the chances of success and the ovaries can be stimulated to produce more eggs. The stimulation of the ovaries is achieved with hormones that are the same ones normally produced by the body. These hormones P.I. 1.3-Assisted Conception Information Booklet-V:1 jan10 UA/AOL Page 2 of 11

3 cannot be taken orally (by mouth) as they are digested and destroyed in the stomach and would not have any effect on the ovaries. These hormones are administered by injection and the clinic will instruct you on how to use and take these hormones. DOWN-REGULATION The first stage of stimulating the ovary is to suppress the woman s own hormone production in the pituitary gland (a small gland at the base of the brain which controls the ovaries). Switching off the pituitary prevents any activity within the body, which could interfere with the stimulation procedure. These drugs are called gonadotrophin releasing hormone agonist (GnRH-a) or antagonists. Treatment is usually started following a period of taking the contraceptive pill and continues right up until the day of egg collection. The GnRH-a can be taken by nasal spray, depot injection (once a month) or daily subcutaneous injections. Exact instructions will be given by the clinic when your treatment starts. Side effects, which may be experienced with these drugs, are described below. A few days after starting GnRH-a treatment a period may occur. This signifies that the pituitary has been suppressed, called down-regulation. STIMULATION After down-regulation has been achieved further hormones will be given in specific and timed daily doses, which will stimulate the ovaries. There are various types and brands that can be used and details will be given by the clinic when treatment begins. These hormones are given by injection under the skin. Each woman will respond slightly differently to these hormones and will be carefully monitored by the clinic. This is done by regular ultrasound scans (to look at and measure the ovaries). The ultrasoun d scan is performed using a small probe in the vagina from which the ovaries can be clearly seen. Ovaries contain follicles, which are small fluid filled sacs. These grow and develop in response to the stimulation hormones. As the follicles grow and develop so does the egg that is contained within the follicle (not every follicle will contain an egg). At a suitable time when there has been enough stimulation of the ovaries a final injection is given which will cause the eggs to finish developing. This is called the human chorionic gonadotrophin (hcg). The clinic will instruct you to have this injection at a specific time, usually at night. It is very important that you have this injection at the time instructed because this is necessary to make sure that the eggs are well developed and can be collected. If you take this injection at the wrong time, we may not be able to collect any eggs or they may not be mature and the treatment will be compromised. EGG COLLECTION The mature eggs are removed from the follicles so that they can be mixed with sperm in the laboratory. The egg collection is usually carried out under sedation, which is a sleepy state where you may feel some discomfort but will not be knocked out. An ultrasound machine is used to watch the ovaries while the eggs are being removed. Your partner is welcome to be present at the time of egg collection. As the ovaries have been stimulated they become enlarged and lie close to the top of the vagina. The egg collection is done with a fine needle, which is attached to a special guide on the ultrasound probe. The needle is passed through the wall of the vagina into the ovaries, which can be seen, on the ultrasound scan. The tip of the needle can be seen on the ultrasound and is placed in each follicle to remove the contents, which will also, hopefully, contain an egg. Every single follicle does not contain an egg and so there may be fewer eggs than the total number of follicles seen during the stimulation of the ovary. P.I. 1.3-Assisted Conception Information Booklet-V:1 jan10 UA/AOL Page 3 of 11

4 The fluid collected from the follicles is passed to the Embryologist who will look at it under the microscope and find the eggs. The eggs are then put in a special fluid (culture medium) and placed in an incubator for a few hours prior to insemination. SPERM COLLECTION On the day of egg collection a sperm sample is required, usually around the same time as the egg collection. The man should abstain from intercourse (ejaculation) for 2-5 days before the egg collection. Abstaining for shorter (less than 2 days) or longer (mo re than 5 days) periods can affect sperm quality and should be avoided. The sperm sample will be prepared to obtain a sample with many motile sperm, which are the sperm capable of getting to, attaching and hopefully fertilising an egg. The prepared sperm are then mixed with the eggs. The eggs will then be checked the following morning at which time the Embryologist will be able to find out how many eggs were fertilised. Occasionally, and unexpectedly, the eggs may not fertilise. The failure to fertilise may occur even if the eggs and sperm do not appear to have any problems. INTRACYTOPLASMIC SPERM INJECTION If there are sperm problems (low sperm count etc) then there may not be enough sperm to mix with eggs to achieve fertilisation. In this case the procedure of intracytoplasmic sperm injection (ICSI) is carried out. The sperm are injected into the egg and this improves the chances of fertilisation for couples with very low sperm numbers or no sperm in the ejaculate. The eggs are collected as described above and if they are sufficiently mature a single sperm will be injected into each egg. The egg is held with a fine glass pipette and a single sperm is identified and picked up with a very fine glass needle. The needle is then gently pushed into the egg and the sperm released. The injection needle is gently removed and the egg put away in the incubator. The eggs are left overnight in the incubator and checked the following morning for fertilisation. As a needle is being placed in the egg, there is a risk of damage to the egg, which is expected to be around 10-15%, although in some cases the eggs may be more fragile and damage more easily. Although there have been many babies born from this treatment, the first was only born in 1992 and therefore the long term safety of this technique is still not fully known. Recent publicity regarding the risks associated with assisted conception techniques (IVF/ICSI) implied there is a slight increased risk of genetic/birth defects. The risk of birth defects in the general population is low, 2% of children born in Europe are born with birth defects. Some research has suggested that there might be an increased risk for babies born as a result of IVF/ICSI. This risk rises to 2.6%, which is still very low. However, the research cannot say with absolute certainty that this increase risk is due to the use of assisted conception techniques rather than other causes such as the age of the patient and the cause of infertility. TRAINING WITH EGGS, SPERM & EMBRYOS Consent will be sought from you to allow the lab to use any spare unfertilised eggs or spare embryos, or sperm samples for the training of laboratory staff in techniques such as ICSI (as above) or for the development of new techniques and services e.g. new embryo freezing techniques. Only eggs and embryos that are unsuitable for your treatment or storage will be used. No sperm will be inseminated or injected into any eggs. If you have P.I. 1.3-Assisted Conception Information Booklet-V:1 jan10 UA/AOL Page 4 of 11

5 any further questions regarding the use of your samples in training then please ask to speak to a member of the lab team. SPERM CRYOPRESERVATION: In ICSI although fewer sperm are needed than for conventional IVF, we do require a certain number of sperm to enable viable sperm to be selected for injection. For some couples therefore it is advisable to cryopreserve sperm samples prior to treatment. This is to ensure that on the day of egg collection sufficient sperm are available for the injection procedure. There is a charge for sperm freezing. Please ask the staff for current price details. Prior to sperm freezing the male partner is required to complete a consent form, which is issued by the HFEA. This form is a legal requirement giving your consent to freezing and also specifies your wishes as to the outcome of the frozen sperm if anything untoward were to happen to you. HFEA requirements also mean you will have routine screening for Hepatitis B, C and HIV. EMBRYO GROWTH The fertilised eggs are placed in the incubator for a total of 2 or 3 days after egg collection. The embryo will be checked to see that they are growing as expected. The egg starts off with one cell which splits into two which each split and so on until about 6-8 cells can be seen on the third day. The embryos are graded on their appearance, which is an indicator of how well they are expected to continue to grow. The grading is a guide only as technology is not yet at the stage where we can predict which embryo will result in a successful pregnancy. EMBRYO TRANSFER The embryo(s) are replaced in the womb with a soft fine plastic tube (catheter). This is a fairly simple procedure similar to a smear test. No anaesthetic is required and the procedure should not cause any discomfort. The neck of the womb (cervix) is viewed with a speculum (also used during smear tests) in the vagina and the cervix is then cleaned with a damp swab. The Embryologist loads the embryos into the catheter. The catheter is then passed gently into the womb and the embryos carefully released. Occasionally there may be a problem in getting the very soft catheter through the small neck of the womb and the Doctor may use an instrument to help him get the embryos transferred. This is not a common problem but there is some discomfort when this instrument is used. However, it is very important to get the embryos in the womb as quickly and as smoothly as possible, which is why the Doctor will try these other methods. AFTER EMBRYO TRANSFER As the pituitary has been down-regulated the woman will need some hormonal support after the embryo transfer. This will usually be given in the form of vaginal or rectal pessaries (progesterone). If the embryo or embryos successfully implant and establish a pregnancy you should not expect a period. A pregnancy can first be detected two weeks after the embryo transfer, usually by means of a urine test, which you can do at home. If there is some bleeding at the end of two the week period this could mean that no pregnancy has been established. If a urine test for pregnancy is positive then a scan will be arranged to confirm the pregnancy. P.I. 1.3-Assisted Conception Information Booklet-V:1 jan10 UA/AOL Page 5 of 11

6 POSSIBLE SIDE EFFECTS The hormones taken may cause the following side effects. The GnRH-a hormones cause down-regulation by switching off the pituitary, which is similar to the changes, which happen after the menopause (change of life). Therefore the side effects, which may be experienced, are similar to some of the experiences of the menopause. GnRH-a may cause hot flushes, irritability, headaches or depression. These symptoms should ease and disappear when the stimulation hormones are taken. A few women may over respond to the stimulation hormones, which will be recognised during the careful monitoring. This response can lead to a condition called ovarian hyperstimulation syndrome (OHSS). If left unattended the consequences of OHSS can be very severe including death. In severe cases the ovaries become enlarged and there is fluid retention in the abdomen (stomach area), which can cause pain or discomfort. There may also be diarrhoea, nausea, vomiting, reduced urine output, thirst, breathlessness and a feeling of faintness or weakness. This is a rare complication. If you have difficulties, please get in touch with us on In case of emergencies, a Consultant is on call 24 hours a day. As a result of ovarian stimulation treatment, there may-be a possible association between this and ovarian cancer but evidence from research studies has been contradictory. Recently, a large population study from Denmark published in February 2009, found no convincing association between the use of fertility drugs and risk of ovarian cancer. POSSIBLE PROBLEMS There are several steps involved in the IVF treatment beginning with down-regulation, ovarian stimulation, egg collection, sperm preparation, fertilisation, embryo transfer and embryo freezing (if performed). Although most couples will proceed through most of these stages there is a chance that one or several of these steps may not work. For example, the ovaries may not stimulate well and the hormone doses can be adjusted to try and improve the response sometimes, however, the response does not improve and we may advise you to cancel your treatment cycle. After egg collection there is a small chance of an infection. To reduce this risk we will administer some antibiotic cover just prior to your egg collection. Some patients experience some bleeding from the needle site in the vagina. This usually subsides quickly. There is a small chance that there may not be any eggs collected. However, this is rare and we will usually get at least one egg from a woman. Once the eggs are collected they are then taken to the lab and mixed with the sperm of your partner or a donor, whichever treatment you have consented to. There is a possibility that the eggs may not fertilise or that they may not develop well and there will not be an embryo transfer. We are not able to predict how the eggs will develop until then, but we can use the information from other treatments to help us improve the result of the next treatment, if you were to come back. If all the steps proceed satisfactorily the final outcome is still not guaranteed, that is a pregnancy is established. Pregnancies established after IVF are still exposed to the same antenatal risks as natural pregnancies such as miscarriage or abnormalities. P.I. 1.3-Assisted Conception Information Booklet-V:1 jan10 UA/AOL Page 6 of 11

7 Although there do not seem to be any greater problems during pregnancies between women conceiving naturally or from IVF, women having IVF tend to be slightly older, which in itself is associated greater risks during pregnancy. Normally we only replace only 1 or 2 embryos in line with current HFEA directives. In women over the age of 40 up to three embryos may be replaced in the womb. There is a chance that if you become pregnant there may be more than one baby; a multiple pregnancy. Multiple pregnancy places a greater physical strain on the mother as well as increasing the risk of complications such as miscarriage and premature delivery (before the due date). The problems arising from this premature birth are low birth weight, higher rate of stillbirth a higher perinatal mortality and higher rate of disability and other health problems. Also, the mother is more likely to have to be admitted to hospital. The average pregnancy is 34 weeks for triplets (three babies), whic h is 4-6 weeks earlier than the due date. These babies often have to stay in the intensive care unit for up to a month and if they progress well they have many hurdles in front of them. Depending on the maturity and weight some babies do not survive. Looking after twins or triplets is very demanding especially for the first three years and the parents face chronic tiredness, anxieties, tensions and a strain on their relationship. The costs of looking after more than one baby should also be considered. OTHER As a unit we endeavour to use high quality, safe and licensed equipment in the assisted conception processes. In addition, we as with many units use off label consumables. This means that products are used for purposes other than those specified by the manufacturer. As a unit we risk assess and batch test equipment as appropriate and frequently audit our results and success rates. EMBRYO FREEZING (VITRIFICATION) Following your embryo transfer if your remaining embryos are of a suitable quality, they may be frozen. This freezing process is called vitrification. This process is a way of preventing the embryos from perishing and using them at a later date. However, not all embryos survive the freezing and thawing process but it is hoped that approximately 70% (two out of three) of the embryos will survive the process. Only good quality embryos will be frozen, as these are expected to have a better chance of surviving the freeze-thaw process. Also studies have shown that up to 5% of embryos can be lost during vitrification. Frozen embryos are stored in tanks containing liquid nitrogen and these are monitored with alarms and are checked regularly. It is very unlikely that any problem will occur during the freezing, storage or thawing period. However, if a problem does arise, CRGW cannot be held liable. Every effort is taken to ensure that problems do not arise and that the embryos will be frozen stored and thawed successfully. REPLACEMENT OF FROZEN EMBRYOS Frozen embryos can either be replaced during a natural or stimulated cycle. Medical or nursing staff will give details of this to you. We ask that you wait for at least one month after your first IVF attempt before coming back for your frozen embryos to be replaced. This gives the woman s body time to recover from the hormone and other treatments of the IVF cycle. Some people are worried that there could be damage to the embryo, which could result in an abnormal baby. At the moment the number of babies born from frozen/thawed embryos is still quite small but there does not seem to be any increased P.I. 1.3-Assisted Conception Information Booklet-V:1 jan10 UA/AOL Page 7 of 11

8 birth problems or defects. However, as with any IVF treatment, there can be no guarantee about the outcome. There is an additional charge for the subsequent thawing and replacement of the embryos. There is also an annual charge for every year the embryos are kept cryopreserved, after the initial year of freezing. COUNSELLING The steps and treatments required during IVF are very intensive, with several visits, many injections and sometimes unexpected problems that can all be very demanding and draining on both partners. It has often been a long road to IVF treatment, with many intrusive and uncomfortable investigations, which are often described as a roller coaster. Family and friends may add to the pressure, usually not meaning to at all. Everyone around you seem to be having babies, colleagues at work may not be sympathetic to your absences and even the relationship between you and your partner is strained. These situations and feelings are not unique and most IVF patients will experience some or all of these pressures. At CRGW we are keen to understand all of your cares, concerns and worries about treatment. All of our staff will seek to provide you with the information and support that you need, in considering treatment, going through it and in coping with the outcome, whatever this should be. It is important that you have the opportunity to think through the implications of treatment to yourself, your family and to any resulting child. Our nurses and doctors are happy to talk this through with you and provide you with any information that you need. We also have a trained and independent counsellor available. We feel that taking time out to talk to a trained counsellor about these issues is a valuable process, which could help both partners a great deal. You will be able to air feelings of isolation, desperation and even anger. Talking to a third person is often easier than with someone you are closer to, giving you a chance to get these feelings and problems out of your system. Our counsellor is independent and has a lot of experience dealing with women s health issues. For the first appointment we do not charge you for counselling, as we strongly believe that it is a part of the IVF treatment, and you can arrange to meet with the counsellor at any stage. Counselling is confidential. THE REGULATIONS The Human Fertilisation and Embryology Act of 1990, which is implemented by the Authority (HFEA), governs the freezing and storage o f embryos for a specific and limited period of time. Normally embryos may be stored for 10 years. In certain circumstances this may be extended but this would require further discussions, consultations and renewal of the consent forms as necessary. At the end of the storage period, if we have not been able to get in touch with you, we are obliged by law to discard the embryos and allow them to perish, regardless of your wishes. CRGW will endeavour to contact you every year (if you still have embryos frozen) to ask if you want them to remain in storage. Although every effort will be made to contact you, it is very important that you keep in touch with the clinic and tell us if you change your address or other circumstances. It is very important to bear in mind that these embryos could remain frozen for 10 years, during which time many circumstances may change. It is for these reasons that you should consider very carefully your wishes for the future of the frozen embryos. In the P.I. 1.3-Assisted Conception Information Booklet-V:1 jan10 UA/AOL Page 8 of 11

9 event of a partner s death or in the break-up of a relationship, decisions will have to be made concerning the future of your embryos. Although this is a difficult subject, you are asked to discuss this before the embryos are frozen and make decisions regarding your wishes for the future. If anything were to happen to either partner, we will be obliged to carry out the wishes of that person specified on the consent from, such as allowing the embryos to perish etc. The consents given before embryos are frozen are binding, however these can be changed or withdrawn at any time, unless the embryos have already been used for treatment. You can change consents by coming in to the Unit and signing new consent forms, but both partners will have to come in and discuss their changes in consent and sign new forms. Withdrawal of consent must be made in writing. Should any partner withdraw their consent there is a cooling-off period of up to 12 months from the date consent is withdrawn. During this time all reasonable steps must be made to notify the intended recipient. If both parties involved agree, then the embryos will be discarded. The 12-month cooling-period cannot exceed the statutory 10-year storage period. CONSENT There are various consents we need prior to undertaking treatment. The consent booklet has all the areas we need to cover and obtain consent for e.g. consent for treatment, disclosure of information, cryopreservation etc. Further details about consent and legal parenthood can be obtained from THE HUMAN FERTILISATION AND EMBRYOLOGY AUTHORITY (HFEA) The HFEA was established to licence, monitor and regulate clinics performing IVF and treatment involving human sperm, eggs and/or embryos in accordance with the Human Fertilisation and Embryology Act of 1990 (amended 2008). In addition to ensuring that all licensed clinics are providing these treatments within the laws and guidelines of the Act, the HFEA also aims to safeguard the interests of patients and the welfare of the children born as a result of this treatment. The HFEA has members appointed by the UK Health Ministries and at least half of these members are neither doctors nor scientists working in the field of infertility so that an independent perspective can be maintained. The members represent a broad range of experiences and backgrounds such as social, legal, lay, religious, medical and scientific representatives. The HFEA carries out the following roles: Inspects and licences clinics offering treatment to infertile couples. Monitors and regulates licensed clinics. Publishes a Code of Practice giving guidelines to centres about carrying out licensed activities. To keep a formal register of information about treatments, patients, children and donors. To provide advice and information to patients, clinics and donors. To constantly review the field of infertility treatment and provide recommendations to the government when asked to do so. P.I. 1.3-Assisted Conception Information Booklet-V:1 jan10 UA/AOL Page 9 of 11

10 The HFEA has a duty to collect information about the treatments and outcomes from licensed clinics, which it publishes regularly. The register was set up in 1991 and contains information about all treatments, donors and children born from that date onwards. Information about patients, donors and children is CONFIDENTIAL and will not be given out by the HFEA If you would like more information about the HFEA you can contact them directly at HFEA 21 Bloomsbury Street London WC1B 3HF Tel: (020) , Fax: (020) , Website at LEGAL PARENTHOOD ISSUES On the 6th April 2009, the HFEA introduced a new law relating to legal parenthood. This law affected who can be registered as a child s legal father or second parent when the child has been conceived following fertility treatment. This only applies to patients undergoing fertility treatments using donor sperm or donor embryos. Different consent forms are required depending on whether the couple are married, in a civil partnership or not and enables the patients involved to give their consent to be recognised as the father or second parent of any child born. This law does not apply to patients using their husbands or partner s sperm in their own treatment as, in this instance, they will automatically be the legal father of any child born. SUGGESTIONS AND COMPLAINTS PROCEDURE All staff at the Centre for Reproduction and Gynaecology Wales believe in providing the highest standard of care and to provide the best possible service with sensitivity to the pressures and strains that infertile couple face. We would like to hear from you if there are any aspects of the service or quality of care you have received is below expectation, or if you have any suggestions as to how we may improve the Unit please let us know. Any complaints or comments that you have will not affect your clinical treatment. Please feel free to let us know if you have any suggestions or complaints or you may contact: Dr H Tejura, CENTRE FOR REPRODUCTION AND GYNAECOLOGY WALES ELY MEADOWS Rhodfa Marics Llantrisant CF72 8XL Or: HFEA- details as previous. P.I. 1.3-Assisted Conception Information Booklet-V:1 jan10 UA/AOL Page 10 of 11

11 SUCCESS RATES AT THE CRMW We are a new purpose built unit. As such we will not have information about our success rates at the unit for 9-12 months. However, our aim is to be able to provide you with the best care and therefore giving you the optimal chance of success. There are many factors which affect your chance of getting pregnant. The principle one is age. The other factors which are important are as follows Smoking (both partners) Ovarian reserve (i.e. the number of eggs left- tested by a blood test called AMH) BMI PAYMENT FOR TREATMENT CYCLE Payment for all treatments is required before starting ovarian stimulation, i.e. at the time of baseline scan. P.I. 1.3-Assisted Conception Information Booklet-V:1 jan10 UA/AOL Page 11 of 11