A guide to the Fertility Unit

Transcription

1 A guide to the Fertility Unit Welcome The following information describes the services offered at the Fertility Unit at the Royal Derby Hospital. If you have any further questions, please do not hesitate to contact us. The Fertility Unit offers a full and comprehensive range of infertility investigations for both male and female patients. We pride ourselves in investigating and treating each couple in an individual, friendly and sympathetic way. Our aim is to try to achieve a pregnancy for as many couples as possible. We also offer support to couples throughout their fertility journey, from referral through to treatment, including intrauterine insemination and IVF, adoption or starting to come to terms with childlessness. Major causes of fertility problems The major causes of fertility problems are: Failure to ovulate Sperm insufficiency, eg. quantity and/or quality Damage to the fallopian tubes preventing the egg and sperm coming together Endometriosis Unexplained infertility - for nearly one third of people 1 there seems to be no obvious cause for the infertility as everything appears to be normal Investigations carried out by the Fertility Unit Your GP will routinely carry out initial hormone blood tests for the female and semen analysis for the male before referral to us. Additional investigations that are suitable for you and your partner will be discussed with you during your first appointment. Patient information leaflets are available for specific investigations and will be given to you as necessary. The investigations that are carried out by the Unit are: Hysterosalpingogram (HSG) This is an x-ray examination of the fallopian tubes to ensure the tubes are not blocked. It needs to be performed during the 10 days following the start of a period. The patient information leaflet explains how to book this test. It is performed in the Children s X-Ray Department. A negative Chlamydia swab is needed before this test can be done. Chlamydia screening is routinely done by your GP before referral, but if this has not been done we will advise you to visit your GP or local family planning clinic.

2 Ovarian Reserve Testing The Fertility Unit offers both blood tests and ultrasound examinations to assess ovarian reserve. Ovarian reserve gives doctors an indication of which treatment is most suitable. Anti Mullerian Hormone (AMH) This blood test measures the hormone excreted by the granulosa cell which surrounds the follicles in the ovaries. Follicles are the fluid filled sacs on the ovaries which contain the egg which is released at ovulation. Results are reported in numerical value and fit into ranges; optimal, satisfactory, low and undetectable fertility. Antral Follicle Scan (AFC) This ultrasound examination looks at the ovaries and the number of tiny follicles that are present in each ovary. This examination is ideally performed from day 5-10 of the menstrual cycle but can be done at any time. Research has shown that as the ovaries age, the number of these tiny follicles declines. The result of these tests advises of a female patient s fertility potential and what treatment is best suited to the number of follicles remaining in the ovaries. Laparoscopy and dye A telescopic-type instrument is passed through a small cut in the umbilicus (belly button). This gives a good view of the ovaries, fallopian tubes and uterus (womb). A dye is passed through the cervix and can be seen spilling from the end of the fallopian tubes into the abdominal cavity. This investigation will also be able to detect signs of endometriosis. This procedure requires a general anaesthetic (which means you will be asleep throughout) and is carried out in the Gynaecology Day Case Unit. Hysteroscopy This procedure involves a small flexible tube being passed through the cervix into the womb to view the cavity. It is routinely performed to confirm and treat common problems, for example polyps or fibroids that have been seen during an ultrasound examination. This procedure is routinely carried out in the Gynaecology outpatient department or if a general anaesthetic is required in the Gynaecology Day Case Unit. Semen analysis (for fertility and following a vasectomy) Please ring to book an appointment. Your GP will provide you with either a semen analysis (white) form or a post vasectomy semen analysis (green) form. These forms have further information about phoning to book an appointment to provide a sample, and do s and don ts before attending for the appointment. Appointments are available daily in the mornings (including weekends) and two afternoons a week. Infertility semen analysis This test looks at volume, ph, viscosity, total count and activity of sperm. A test preparation will require 2 appointments. Please telephone to book an appointment. Your GP/consultant will provide you with a referral form. Other tests include morphology, anti-sperm antibodies and test preparation available upon request by your GP or consultant. Post vasectomy semen analysis This looks at volume, ph, viscosity, total count and activity of sperm. If no sperm are seen after initial analysis, further tests are performed to confirm the absence of sperm. If the sample does contain sperm, a further test is required approximately 4 weeks later.

3 Treatments provided by the Fertility Unit Clomiphene citrate (Clomid) This is a commonly used fertility drug. It is taken once a day for 5 days, from day 2 of the cycle up until day 6 (inclusive). Your doctor may offer several cycles of this drug to improve or enhance ovulation. Monitoring of the effectiveness of the drug is done by performing blood tests in the first cycle and occasionally follicle tracking is offered. Clomiphene is a relatively mild drug with few side-effects. Hot flushes are sometimes experienced. Nausea and occasional headaches are less common. Superovulation This uses drugs called gonadotrophins (Menopur and Gonal F). These drugs are the hormones that are naturally produced by the female at the beginning of the menstrual cycle. Gonadotrophins are stronger drugs, given by injection on a daily basis, and require close monitoring by both scans and blood tests. Follicle tracking This involves a series of trans-vaginal scans performed around the time of ovulation. A small probe is placed inside the vagina and the thickness of the womb lining and size and number of follicles are measured by ultrasonic waves. These results are reviewed by the nurse specialist and either a repeat scan or blood test is ordered along with advice regarding timing of sexual intercourse. Intra-uterine insemination (IUI) Intra-uterine insemination involves the placing of freshly prepared sperm (from your partner) high in the uterine cavity at the most fertile time in your menstrual cycle. Medications to improve and enhance ovulation are given at the beginning of your cycle. A scan will be arranged to monitor follicle development and the results will be assessed by the nurse specialist. If following the scan, the follicles and womb lining have developed sufficiently, an additional hormonal injection is given to mature the follicle and induce egg release (ovulation). Two days later your partner will come into the Unit and produce a sperm sample. The sample is then spun to separate the sperm from the seminal fluid. We check it to see how many sperm we started with and how many we have after preparation (some are always lost, but hopefully we have a much higher number of active sperm following preparation). This process takes up to two hours. The sample, approximately 1ml, is then placed via a thin catheter directly into the womb. This procedure is carried out on an outpatient basis; you will not need to stay in hospital. Regular intercourse is advised in the days following insemination. If the insemination has been unsuccessful a period will follow 2 weeks following the treatment. If a period does not arrive then a pregnancy test is advised 5 days after it was due. The NHS funds a limited number of cycles per patient, this will be discussed with you before treatment is started.

4 Donor insemination (DI) Donor insemination is available on a self funded basis at the Fertility Unit. Donor insemination is performed the same way as intrauterine insemination but uses donor sperm instead. This treatment is available for single women, same sexed couples or for couples where the male has no sperm at all. This method needs very careful discussion and counselling around the various issues associated with using donor sperm is compulsory. This may not be suitable or acceptable for some couples. Donor sperm is collected from volunteers who are carefully screened for HIV and Hepatitis and some genetic disorders. Once collected, the sperm is frozen and is only available for use when further testing of the donor has been carried out 6 months later. Since the removal of donor anonymity the availability of donor sperm is extremely limited and sperm sometimes has to be obtained from abroad. The Human Fertilisation and Embryology Authority provide the Fertility Unit with a licence to perform IUI and DI treatment. The HFEA closely monitors the services the Fertility Unit provides and performs a detailed inspection every three years. Other services provided by the Fertility Unit Satellite IVF The Fertility Unit also offer a satellite service for NHS and self funded IVF patients with CARE at Nottingham. Consultations, scans and blood tests are performed in Derby but egg collection, fertilisation and embryo return is performed in Nottingham. Endometrial scratching This is a relatively new procedure; initial research findings suggest performing an endometrial scratch in the cycle immediately before embryo transfer improves successful IVF outcomes. The procedure is performed in the latter half of the menstrual cycle in the Fertility Unit and is similar to having a smear test performed. 3D Ultrasound Scan A three-dimensional scan enables the scanner to produce 3D images of the womb and/or ovaries and can show abnormalities more clearly than a conventional two dimensional scan. This examination is currently only available on a self funded basis. Useful contacts and organisations Fertility Unit Royal Derby Hospital Open: Monday, Wednesday and (2 nd, 3 rd & 4 th ) Thursday, 8.00am pm Tuesday and (1 st & 5 th ) Thursday, 8.00am pm Friday, 8.00am pm Saturday and Sunday, 8.00am pm Telephone: If you have any queries, or require further information please telephone and ask to speak to one of the Fertility Sisters.

5 HFEA - Human Fertilisation and Embryology Authority Finsbury Tower Bunhill Row London EC1Y 8HF Telephone: admin@hfea.gov.uk Website: Infertility Network UK Charter House 43 St Leonards Road Bexhill on Sea East Sussex TN40 1JA Freephone: admin@infertilitynetworkuk.com Website: Listening to your views We always aim to provide the best possible care during your treatment. Your views are very important and help us to develop our services. If you have any suggestions, comments or concerns, please speak to a member of staff. It is important that we endeavour to resolve your concerns as quickly as possible. If staff are unable to help they will make arrangements for you to talk to someone else. You may wish to speak to a member of the Patient Advice and Liaison Service (PALS) about your concerns or for advice regarding making a formal complaint. Please tell us where the service met or exceeded your expectation so that we can build on good practices. This encourages staff to improve and maintain high standards across the Trust. Reference 1. NICE (2012) Fertility assessment and treatment for people with fertility problems. RCOG Press: London Any external organisations and websites included here do not necessarily reflect the views of the Derby Hospitals NHS Foundation Trust, nor does their inclusion constitute a recommendation. Reference Code: P1667/0624/ /VERSION8 Copyright All rights reserved. No part of this publication may be reproduced in any form or by any means without prior permission in writing from the Patient Information Service, Derby Hospitals NHS Foundation Trust. (P083/ /V7)