Your guide to the facts of fertility

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1 Your guide to the facts of fertility What is infertility? Infertility is defined by the World Health Organisation ( WHO ) as the inability of a couple to conceive after a year or more of regular unprotected sex Types of infertility Primary - where pregnancy has never occurred. Secondary - where one or both members of the couple have previously conceived but are unable to conceive again after a year of trying. When should we become concerned about not becoming pregnant? When a couple has failed to conceive after one year of well-timed intercourse. Where the woman is older than 35, after 6 months of well-timed intercourse, they should seek expert advice. The chances of a successful pregnancy decreases with age.

2 Your first visit At Origin Fertility Care, we understand that your first visit may be a daunting one, especially if you have never experienced fertility problems before. Our goal is to make this visit as straightforward as possible for you. 1. Making an appointment 2. Initial Appointment 3. Doctor Consultation How do I make an appointment? At Origin Fertility Care, we do not require a referral letter from your GP/Consultant. You can make an appointment directly by calling our Belfast Clinic on +44 (0) or our Sligo Clinic on However, if your GP/Consultant has referred you, we will require a referral letter. Initial Appointment Once we receive this referral letter if you have been referred by a GP/Consultant, we will send you an appointment to attend an initial consultation or this can be arranged directly over the phone if you are contacting the clinic directly. At this appointment the female partner will have an Anti-Mullerian Hormone (AMH) blood test while the male partner will have a semen analysis, if appropriate. When the results of these tests are available, you will be given an appointment for a consultation with one of our fertility doctors. Consultation At this consultation, we will look at the medical and fertility history of both partners. The female partners may require a scan and, in some cases, the male partners may also be examined. This scan and the test results may help to identify the underlying problem and provide firm guidelines as to the most appropriate treatment, although this is not always the case. In all cases, your first visit will result in a formal assessment, as required by the HFEA. This will enable us to recommend appropriate tests and treatments, define the nature of that treatment and its cost. We will also give you our opinion of the likelihood of success and you will have the opportunity to ask any questions you may have before commencing treatment. For more information on fertility treatments and related costs, see the treatments section and fee schedule section of the information pack.

3 Initial tests Anti-Mullerian Hormone (AMH) Test For couples who are not sure if they have fertility problems but who are experiencing trouble conceiving, we offer straightforward, initial, low costs tests; an Anti-Mullerian Hormone (AMH) Test for females and a Semen Analysis Test for males and with no waiting lists, if required, treatment can commence as soon as you are ready. Anti-Mullerian Hormone (AMH) Test What is it? It has been established that the Anti-Mullerian Hormone (AMH) which is made by the developing ovarian follicles (which contain eggs), can tell how a woman s ovaries will respond to fertility drugs. When would you need an AMH test? All patients who want to commence treatment with Origin Fertility Care must have an AMH test as this is an initial investigation test. What is the process involved? The AMH test is usually part of the consultation process or can be done as a one off test to test your ovarian reserve. Origin Fertility Care can only advise you of the result as part of the consultation process. What is the cost? To find out the costs, see our fee schedule section of the information pack. How to arrange an AMH test at Origin Fertility Care The blood test can be performed at any stage in the menstrual cycle. Please phone reception and our administration team can arrange an appointment. Belfast Clinic +44 (0) Sligo Clinic A normal AMH result is valid for two years. If you wish to discuss the benefits of AMH testing further, please do not hesitate to contact a member of our clinical or nursing team.

4 Initial tests Semen Analysis Test For couples who are not sure if they have fertility problems but who are experiencing trouble conceiving, we offer straight forward, initial, low costs tests; an Anti-Mullerian Hormone (AMH) Test for females and a Semen Analysis Test for males and with no waiting lists, if required, treatment can commence as soon as you are ready. What is it? Semen Analysis A test performed by a trained andrologist or embryologist to examine the sperm cells within the semen. Parameters of count, motility and morphology (shape) are examined and reported according to World Health Organization ( WHO ) guidelines. What is the process involved? Arrival at clinic Shown to a private room to produce sample Confirmation of identification Instructions given by embryologist Sample produced Leave sample in instructed location When would men need a semen analysis? All patients who want to commence treatment with Origin Fertility Care must have a Semen Analysis as this is an initial investigation test. If the male is experiencing problems during intercourse for example, inability to ejaculate or sustain an erection. Extended Semen Analysis The Extended Semen Analysis includes our standard semen analysis test and the SpermComet which tests for sperm DNA damage. What is the cost? To find out the costs, see our fee schedule section of the information pack. How do I arrange a Semen Analysis Test? To book a semen analysis test: Call our Belfast Clinic on +44 (0) Call our Sligo Clinic on For more information about semen analysis visit our website at. Semen samples should be analysed following 4 days of sexual abstinence but no longer than 6 days. Please remember this when booking your appointment.

5 Treatments offered There is a pre-conception that the only fertility treatment is IVF but there are many different types of fertility treatment available. Ovulation Induction (OI) In Vitro Fertilisation (IVF) This involves a woman taking a course of fertility drugs to stimulate her ovulation. Fertility drugs are hormones that work in different ways to stimulate the woman s body to produce and release a mature egg from the ovary. The egg is then fertilised naturally. This treatment may be suitable for couples where the woman has problems ovulating properly. This involves the woman taking drugs to stimulate her ovaries. Her eggs are then collected and mixed with prepared sperm in the laboratory. When the eggs have been fertilised, the best quality embryos are selected and a maximum of two placed back inside the womb. This limits the chances of multiple pregnancies. IVF can be suitable for couples with many forms of infertility, including those with blocked tubes. Intra uterine insemination (IUI) Fertility drugs are used to stimulate egg production as above and ultrasound scanning is used to assess the development of the egg. A sperm sample is then collected from the male partner and prepared in the laboratory so that stronger sperm can be placed inside the woman s womb at the appropriate time in her menstrual cycle. This may be suitable for couples where there is a male partner and he has poor sperm quality, the woman has problems ovulating or a combination of both. Intra Cytoplasmic sperm injection (ICSI) ICSI can help couples who have failed using standard IVF or if there is a male partner and he has a very low sperm count. Eggs and sperm are collected as they would be for standard IVF but instead of mixing the eggs with lots of sperm, a single sperm is injected into an egg. The embryo is then placed back inside the womb as in IVF. There are some other variations to the treatments listed above but the treatment you and your clinician choose will always be best suited to your needs.

6 Ovulation Induction (OI) What is OI? Ovulation Induction involves stimulating the ovaries to produce an egg. When would you need OI? This treatment is used when there is an ovulation problem. Patients requiring this treatment often have absent menstrual periods. Prior to starting, the fallopian tubes are usually checked to ensure they are open and the sperm should also be normal. What is the typical cost? Our OI fee schedule varies depending on the number of cycles and drugs required. To find out the costs see our fee schedule section of the information pack. What does the OI process involve? Female given a course of drugs to stimulate ovaries Monitoring and regular scanning to check follicle development Beginning of ovulation Timed intercourse or sperm injected through cervix (IUI) Our support At Origin Fertility Care, our team of professionals will be with you at every stage of the process and will answer any queries or concerns you may have. We aim to make the OI process as simple and pain free as possible for you as we understand and appreciate that this is a stressful time. For some patients, one cycle of OI works first time, for others they may need to have multiple cycles. To support you in this journey, we offer complimentary counselling with our fertility counsellor Patricia McCrystal. Get in touch For more information on Ovulation Induction treatment at Origin Fertility Care contact us on: Call our Belfast Clinic on +44 (0) Call our Sligo Clinic on

7 Intrauterine Insemination (IUI) What is IUI? Intrauterine Insemination may be performed where a couple s investigations have failed to detect a specific cause of infertility. The woman is usually given a course of fertility drugs and the man s sperm is prepared so that the healthiest can be selected. IUI involves the introduction of sperm high in the uterus of the woman. This is a painless procedure. When would you need IUI? IUI may be suitable for patients who have Unexplained infertility Single women or same-sex couples who want to conceive and need donor sperm When there is a problem with the couple having normal sexual intercourse What does the IUI process involve? Ultrasound scan Drugs prescribed and demonstration given by nurse on how to use Monitoring and regular scanning to check follicle development Once follicle grown to appropriate size trigger drug prescribed to help ripen the egg Date and time of IUI procedure to be arranged What is the typical cost? Our IUI fee schedule varies depending on the number of cycles and drugs required. To find out the costs, see our fee schedule section of the information pack. Our support At Origin Fertility Care, our team of professionals will be with you at every stage of the process and will answer any queries or concerns you may have. We aim to make the IUI process as simple and pain free as possible for you as we understand and appreciate that this is a stressful time. For some patients, one cycle of IUI works first time, for others they may need to have multiple cycles. To support you in this journey, we offer complimentary counselling with our fertility counsellor Patricia McCrystal. If male partner is present, they must attend clinic at a specific time to produce a sample/if no male partner present, donor sperm sample must be available Get in touch IUI procedure performed For more information on IUI treatment treatment at Origin Fertility Care contact us on: Call our Belfast Clinic on +44 (0) Call our Sligo Clinic on

8 In-Vitro Fertilisation (IVF) What is IVF? IVF is fertilisation outside the body and involves combining eggs with sperm in a culture dish. In vitro literally means in glass. When would you need IVF? Unexplained infertility Blocked or damaged tubes Male factor infertility What is the process involved? Egg production Egg collection Sperm sample Sperm and eggs prepared together Embryos (fertilised eggs) transferred to the woman Pregnancy test Egg production The woman is prescribed fertility drugs to encourage the ovaries to produce more eggs than usual in a normal monthly cycle. This is usually a daily injection that the woman is required to take. The woman will be monitored carefully by our clinical team through regular ultrasound scans. Once the follicles around the eggs have grown to a required size, a final injection is administered to help the ripening of the egg. Egg collection The eggs are collected under mild sedation which involves a fine hollow needle being passed by ultrasound guidance via the vagina. Eggs are placed into an incubator. Sperm sample On the same day the male partner is asked to produce a sample of sperm. This will be performed in our sperm production room. The most motile sperm are selected. Insemination of sperm and eggs The sperm sample together with the eggs are prepared and placed together in a special medium. They are kept in an incubator and examined the following day to see if they have fertilised. Embryo transfer If embryos (fertilised eggs) have developed they can then be transferred into your uterus. This procedure does not require sedation. The embryos can then begin growing as a normal pregnancy. Pregnancy test The final stage is then to take a pregnancy test approximately two weeks later.

9 In-Vitro Fertilisation (IVF) What is the typical cost of IVF? Our IVF fee schedule varies depending on the number of cycles and drugs required. To find out the costs, see our fee schedule section of the information pack. Our support At Origin Fertility Care, our team of professionals will be with you at every stage of the process and will answer any queries or concerns you may have. We aim to make the IVF process as simple and pain free as possible for you as we understand and appreciate that this is a stressful time. For some patients, one cycle of IVF works first time, for others they may need to have multiple cycles. To support you in this journey, we offer complimentary counselling with our fertility counsellor Patricia McCrystal. Get in touch For more information on IVF treatment at Origin Fertility Care contact us on: Call our Belfast Clinic on +44 (0) Call our Sligo Clinic on

10 Intracytoplasmic Sperm Injection (ICSI) What is ICSI? Eggs and sperm are collected in exactly the same way as IVF but, instead of mixing the eggs and sperm, one single sperm of best quality is selected and this is then injected directly into the centre of an egg and the embryo is then placed in the womb in exactly the same way as in the IVF treatment. When would you need ICSI? Low sperm count Poor sperm motility High percentage of abnormal shaped sperm Cases where sperm has been surgically collected from the man because of an obstruction or failed vasectomy reversal Where the fertility issue lies with the male and IVF has failed What is the ICSI process involved? Egg production Egg collection Sperm sample One single sperm selected and injected into an egg Embryos (fertilised eggs) transferred to the woman Pregnancy test Egg production The woman is prescribed fertility drugs to encourage the ovaries to produce more eggs than usual in a normal monthly cycle. This is usually a daily injection that the woman is required to take. The woman will be monitored carefully by our clinical team through regular ultrasound scans. Once the follicles around the eggs have grown to a required size a final injection is administered to help the ripening of the egg. Egg collection The eggs are collected under mild sedation and involves a fine hollow needle being passed by ultrasound guidance via the vagina. Eggs are graded and placed into an incubator.

11 Intracytoplasmic Sperm Injection (ICSI) Sperm sample On the same day the male partner is asked to produce a sample of sperm. This will be performed in our sperm production room. The most motile sperm are selected. Insemination of sperm and eggs The healthiest single sperm is selected and injected into the centre of the egg. Embryo transfer If embryos (fertilised eggs) have developed, they can then be transferred into your uterus. This procedure does not require sedation. The embryos can then begin growing as a normal pregnancy. Pregnancy test The final stage is then to take a pregnancy test approximately two weeks later. What is the typical cost of ICSI? ICSI is the most expensive type of fertility treatment due to the complexity of the situation and the embryological work involved. Our ICSI fee schedule varies depending on the number of cycles and drugs required. To find out the costs of ICSI treatment, visit our fee schedule section of our website. Our support At Origin Fertility Care, our team of professionals will be with you at every stage of the process and will answer any queries or concerns you may have. We aim to make the IVF process as simple and pain free as possible for you as we understand and appreciate that this is a stressful time. For some patients, one cycle of IVF works first time, for others they may need to have multiple cycles. To support you in this journey, we offer complimentary counselling with our fertility counsellor Patricia McCrystal. Get in touch For more information on ICSI treatment at Origin Fertility Care contact us on: Call our Belfast Clinic on +44 (0) Call our Sligo Clinic on

12 Supporting you through your treatment Our counselling service After care services At Origin Fertility Care, we realise that there is more to the patient journey than just your fertility treatment. There is considerable evidence that stress can have an impact on fertility. For many, assisted conception can be the end of a long and difficult journey of trying to conceive and this is often an emotional and trying time. As we work in partnership with our patients towards achieving a successful pregnancy, our counsellor is part of that team, helping to reduce patient stress and improve mental wellbeing as part of the treatment process. Although not compulsory, we strongly recommend that patients avail of the counselling service as we believe that it makes a valuable contribution to treatment. Our counsellor, Patricia McCrystal has been working with Origin Fertility Care since its inception. Patricia is HPC registered and practices as a Counselling Psychologist in the field of Health Psychology in a local Trust. She has a special interest in infertility and mental wellbeing and is accredited by the British Infertility Counselling Association. She played a key role in establishing the counselling service at Origin Fertility Care and continues to manage this in an independent capacity. For more information on our counselling service, please see our counselling service leaflet enclosed in this pack. As our gift to you, if you successfully become pregnant, we offer a pregnancy pack with a range of aftercare services at a discounted rate in conjunction with 3fivetwo Healthcare, part of the 3fivetwo Group. These services include: Private Antenatal Care Scans - including 4D, normality, fetal wellbeing, chromosomal conditions such as Down s Syndrome testing Wellbeing services for the pregnant mothers - physiotheraphy, pilates, dietician services Paediatrics Post birth services - cosmetic and plastic surgery, post pregnancy personal training, medical insurance For more information about the pregnancy pack or for further information on any of the 3fivetwo services, please speak to the consultant at your appointment.

13 Typical patient pathway Enquiry/referral made Appointment set up for an AMH and Semen Analysis (if appropriate) Consultation with the clinican re: results and treatment plan and screening bloods taken by the nurse (if appropriate) Review appointment (if counselling required or issue with screening bloods) or planning appointment (to commence treatment) Commence appropriate treatment *Please note this is a typical patient pathway and some patients may require extra steps e.g further investigations

14 Why choose Origin Fertility Care? üüthe longest established private fertility clinic in Northern Ireland üüsuccess rates üü No waiting lists üücompetitive fee schedule including treatment package prices üübespoke patient care with individualised treatment schedules üücaring, friendly and supportive network of skilled nurses and counsellors üü24-hour nurse on-call service üüeasily accessible from all main routes üüfree on-site parking Success Rates The chance of achieving a pregnancy is different for each patient. Important factors include female age and reproductive health, sperm quality and fertility history. Our doctors will discuss each individual case taking all influencing factors into account and aim to give you realistic advice about your chances of having a baby. Origin Fertility Care welcomes female patients up to the age of 45 and male patients to age 60. Our success rate exceeds the HFEA national average. Our success rates are published regularly on our website. /success-rates A number of factors contribute to a clinic s results ranging from the services offered to the criteria for allowing treatment, with success rates varying from year to year with the introduction of new reproductive technologies.

15 Our team At Origin Fertility Care, we believe that our complement of staff is our greatest strength. Many factors contribute to a clinic s ability to help patients achieve successful pregnancies, but after the age and physical wellbeing of the patients, the single greatest factor is the skill and competence of the treatment team. At Origin Fertility Care, we are proud of our excellent team of highly qualified consultants and embryologists, and of our caring, friendly and supportive network of skilled nurses, counsellors and receptionists. Our Senior Management Team Clinical Director Dr Noel Heasley Dr Noel Heasley is the Clinical Director at Origin Fertility Care. Noel has 25 years experience as a consultant in Northern Ireland. He worked as a senior lecturer/consultant in Belfast s teaching hospitals and was part of the IVF team at that time. He later moved on to join the NHS as a Consultant Gynaecologist in Craigavon Area Hospital with special interest in infertility. He was responsible for establishing an area infertility clinic and providing services including ovulation induction and intrauterine insemination. We are confident that, with his long experience of dealing with infertile couples, Dr Heasley s appointment has strengthened the clinical team and has greatly enhanced our plans to develop the services we offer at Origin Fertility Care. Embryology Manager / CPD Co-Ordinator Dr Steve Green Dr Steve Green has been practicing as a Clinical Embryologist since Steve has been recognised for his work in Embryology for achieving the world s first pregnancy and delivery after simultaneous sperm and egg transfer to the uterine cavity in 1981, the first UK IVF twins in 1982, the first UK IVF triplets in 1984 and the first pregnancy and delivery after using computer image selected sperm in In most recent years, he has devoted much of his effort to the treatment of male factor infertility. With over 70 publications and book chapters to his credit, Steve brings a wealth of experience and a passion to deliver the best possible treatment for couples suffering from infertility and his main role in Origin Fertility Care will be to develop and expand the services currently being offered. Operations Manager Jennifer McLaughlin Jennifer McLaughlin joined Origin Fertility Care in March 2012 as a Nurse. Jennifer brings with her a wealth of experience in nursing previously working in a number of key nursing roles. She soon progressed to the role of Nurse Lead where she oversaw the day to day operations of the nursing team and developed their competencies and skills. Her new role as Operations Manager will be to oversee the day to day activity of the clinic and to take a forward thinking approach to developing new ideas within the clinic.

16 The next steps The team at Origin Fertility Care hope that you found this information pack informative and beneficial. If you have any queries or concerns, or if you would like to ask further questions, please do not hesitate to contact our administration team in the first instance on +44 (0) (Belfast), (Sligo) or Make an Appointment If you would like to make an initial appointment, please contact our administration team: Telephone: (Belfast) (Sligo) Website: Origin Fertility Care, 380 Belmont Road, Belfast, BT4 2NF. Origin Fertility Care, Kingsbridge Private Hospital, Ray MacSharry Road, Sligo.

17 How can I pay for private fertility treatment? If you opt to pay for your fertility treatment in instalments, we will put you in contact with our recommended finance provider, Zebra Health Finance. They can offer you a simple and easy monthly payment plan to allow you to access private fertility treatment when you need it most. Zebra Health Finance has been established for over 10 years and is the leading provider of finance within the healthcare market in the UK. With their help, you will be able to discuss the payment options available to you and proceed with the treatment you need without delay. Benefits of a private medical loan: If you are interested in making an application for a private medical loan, there are four ways you can apply: Call: By calling Zebra Health Finance directly on Opening hours are: Monday to Friday - 8am to 7pm Saturday - 9am to 5pm DD DD DD DD Patient discretion is assured Loan amounts to pay for the full cost of most treatments Monthly loan terms to suit most budgets Representative 27.8% APR (variable) - includes a one-off Administration Fee Online: By going online at Post: By requesting an application form from Origin Fertility Care which you can complete and send directly to Zebra Health Finance by post. Visit: By visiting Origin Fertility Care in person to complete an application form which we will send to Zebra Health Finance on your behalf.

18 We want to hear from you We respect the rights of our patients and we are always happy to receive both positive and negative feedback. If for any reason you find any part of your treatment journey unsatisfactory, we have a dedicated complaints procedure to deal with this. If you wish to make a complaint, please contact our Operations Manager, Jennifer McLaughlin on the main clinic number and she will deal with this accordingly. Telephone: Website: Origin Fertility Care, 380 Belmont Road, Belfast, BT4 2NF. Origin Fertility Care, Kingsbridge Private Hospital, Ray MacSharry Road, Sligo.

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