DIMITRIOS NIKOLAOU MD MRCOG Consultant Obstetrician-Gynaecologist Sub-specialist in Reproductive Medicine and Surgery

Transcription

1 DIMITRIOS NIKOLAOU MD MRCOG Consultant Obstetrician-Gynaecologist Sub-specialist in Reproductive Medicine and Surgery Private secretary: Tel: IVF on a Cetrotide protocol with Mr Nikolaou at Chelsea Westminster Here is what you need to do if you have been told that you are on a Cetrotide protocol for having treatment with Mr Nikolaou at Chelsea Westminster: 1) REGISTER WITH ACU First you need to register with the Assisted Conception Unit (ACU). Go to our website in the Chelsea/Westminster page, and it is one of the downloadable documents on your left hand side. You need to this form to the Assisted Conception unit (ACU) to the private patient coordinator, Ksenya, at Ksenya.Kirnitski@chelwest.nhs.uk, and copy at acu@chelwest.nhs.uk Alternatively, you can give the form in person to the receptionist at the ACU. 2) BOOK AN APPOINTMENT WITH THE NURSE Once you have registered, with the ACU, call ACU reception on and ask to make an appointment to see a nurse for a nurse consultation. You need to mention that you are having private treatment with Mr. Nikolaou/Fertility for life. Both you and your partner will need to attend this meeting. You should not start treatment before seeing the nurse as there are important issues to be sorted out first. If there are any problems booking a nurse meeting, you should call the ACU on and ask to speak to Ksenya, the private patient coordinator, or e mail her at Ksenya.Kirnitski@chelwest.hs.uk. 3) The treatment will start with your first period AFTER seeing the nurse. When your period comes, call the ACU reception on to book a treatment scan for day 2 or 3. The scans are done by the sonographer in the morning, am in the ACU. After your scan you always see a nurse. This is the time to ask any questions that you may have about your ongoing treatment. If you have wider issues to discuss, you need to call my secretary and book a consultation. This will be charged at a normal rate as a follow up consultation. 4) If I have given you the oral contraceptive pill microgynon to take before you start your IVF treatment, you need to take it from the beginning of your menstrual cycle the month before the IVF treatment and take it for 21 days. Book your first treatment scan 3-5 days after stopping the microgynon, irrespective of bleeding. Occasionally I will give you 2 packs of microgynon. In this case you need to take the 21 active tablets of the first pack and then move on to the second pack without break, and stop when I tell you. The first scan will be 4-6 days after stopping microgynon. Not everyone has to take the contraceptive pill.

2 5) The purpose of the first scan is to ensure that all is OK to start ovarian stimulation. If there is a problem, such as a big ovarian cyst or an endometrial polyp, we may need to postpone the treatment for another cycle. 6) Assuming all is OK, we will start ovarian stimulation after the first scan, at a dose that will be individual to you. 7) Each time that you have a scan and a blood test, during your IVF cycle, the nurse will show the results to my consultant colleague or me in the afternoon. We will see the chart with the growing eggs and blood levels and decide if we need to change the dose of your medication. The nurses will call you in the afternoon to give you instructions. 8) You will need to have a second scan, and blood test, usually around 5 days after starting ovarian stimulation. At that stage we will assess the ovarian response and may adjust the dose of the medication. We will also start a second daily injection, which is called Cetrotide. The purpose of the first injection (Gonal F or Menopur) is to make the eggs grow. The purpose of the second injection (Cetrotide) is to make sure you will not ovulate until we collect your eggs. 9) You carry on doing both injections daily and we arrange for you to have 1 or 2 more scans and blood tests to monitor the ovarian response. Usually after days of injections you are ready for egg collection. 10) There is an injection that is called Ovitrelle, which triggers the final maturation of the eggs prior to egg collection. The ACU nurse will call you to give you an exact time for having this injection, which will be usually between 8-11pm. Usually 37 hours later we do the egg collection. If we wait much longer you will ovulate. Sometimes we use a different drug instead of Ovitrelle. 11) You will not have any more injections after taking Ovitrelle. The day of egg collection you need to come to the ACU, fasted for 6 hours (no food or drink). Your partner needs to come with you to provide a sperm sample (unless we are using frozen or donor sperm). He needs to abstain from ejaculation for 3-5 days. The nurse will tell you exactly what time to come to the ACU. 12) The egg collection will be done under sedation, which will be administered by a nurse. You will be drowsy but not necessarily asleep. Your partner or a friend will need to take you home. 13) The egg collection will last for 15 min on average. You will go home a couple of hours later. The nurse will give you instructions what to do after an egg collection. The same night you will start using progesterone supplements, usually cyclogest pessaries. You will have one pessary rectally the same day as the egg collection and two a day rectally from the following day. You will be able to use them vaginally after the embryo transfer. 14) The next day you will be contacted by the embryologist by mid-day, to find out if any eggs have fertilized and how many embryos you have. The embryologist will tell you when to come for embryo transfer. This may be revised depending on the number and quality of your embryos.

3 15) You will carry one using progesterone supplements until the pregnancy test. Usually we recommend a urinary pregnancy test 2 weeks after the embryo transfer. Sometimes we also recommend intramuscular injections of progesterone and other medication in addition to the vaginal pessaries. 16) If the pregnancy test is positive you will need to carry on using vaginal progesterone pessaries and book a pregnancy assessment scan by contacting the receptionist at the ACU on This will be 3 weeks after the positive pregnancy test. If the pregnancy test is negative you will stop all medication and wait for a period. Sometimes the bleeding starts before the pregnancy test. If it is only slight bleeding, you carry on with your medication. If it is a heavy period then you stop.

4 General information about private IVF with Fertility for life/mr. Nikolaou at Chelsea Westminster Location: We will do your treatment at the Assisted Conception Unit, Chelsea and Westminster. This is on the 4 th floor, Lift bank D. The nearest underground tube stations are: Earl s Court and South Kensington. Website: E mail: acu@chelwest.nhs.uk (ACU reception) Tel: Fax: Emergency nurse phone number for out of hours: (only use in a real emergency). Alternatively you can call the switchboard of Chelsea Westminster on and ask the receptionist to call the ACU emergency line. Side-effects of drugs Prostap and buserelin can cause menopausal symptoms, such as tiredness, headaches, night sweats, hot flushes, nausea, mood changes. Gonal-F or Menopur can cause headaches, breast tenderness, nausea and tiredness. When you are near the egg collection you may feel heaviness or pulling inside your abdomen as your ovaries will be heavier. The cyclogest pessaries and Crinone cream can cause bloatedness and constipation. With crinone you can experience lumps of brown-stained gell coming out of the vagina. Don t panic, this is just the gel that carries the drug and the brown is almost certainly old blood from the site of the egg-collection. Cetrotide can cause local skin irritation which normally subsides after a few days.

5 Risks IVF is not without risks. We normally discuss them in the planning appointment and I am always happy to provide more clarifications during the treatment. Particularly you should be aware of the following: 1) The risk of poor-ovarian response and cycle cancellation. Note: If a cycle in cancelled before eggcollection, a cancellation fee is charged to cover the cost of work carried out up to that point. This is included in the price-list. 2) The risk of over-response and ovarian hyperstimulation syndrome. We take steps to minimize this risk, which is below 3%, including prevention and management. However, if you develop clinical ovarian hyperstimulation you will normally be admitted at Chelsea and Westminster Hospital through Accident and Emergency. 3) The risks of the operative procedures, including infection and internal bleeding. 4) The possible practical difficulties collecting eggs and transferring embryos in some cases. 5) The risk of multiple pregnancy if you transfer more than one embryo. 6) The risk of miscarriage and ectopic pregnancy 7) The risk of infection, internal bleeding or a surgical complication during the egg collection 8) The risk of an allergic reaction or a side effect of the drugs 9) IMPORTANT: Remember: ovaries don t always respond to stimulation with drugs. We don t always manage to collect eggs. Eggs occasionally fail to fertilize. Not all embryos are good embryos and not all of them survive in culture. There can be no guarantee that you will have extra embryos for freezing. 8) If you do ICSI there is a slightly increased risk of congenital abnormalities of the embryo (up by 0.5%). If the sperm is extremely poor you will be advised to organize genetic tests for your partner.

6 Fees The costs of the treatment are outlined in the price list, which you can find on our website under pricelist. Your treatment is private. You usually pay the following The standard IVF package Your drugs (you buy them separately and the prices vary depending on your protocol, dose, duration of treatment and pharmacy, but the average cost of drugs for an IVF cycle is You can buy form the pharmacy at Chelsea Westminster. Alternatively, my secretary can arrange home delivery from Healthcare at Home. Any additional laboratory procedures such as blastocyst culture, embryo freezing, sperm freezing, AZH (assisted zona hatching), IMZI as above The IVF cycle starts when I do the first scan after starting the medication and finishes when we do the pregnancy test. This does not include extra consultations apart from the normal IVF scans and procedures. It does not cover early pregnancy assessments, or any emergency reviews out of hours. If you have problems in early pregnancy, such as pain or bleeding, you can see your GP or another private gynecologist or go to Casualty at Chelsea Westminster, or call the nurse line at ACU. I may not be personally available to see and examine you in early pregnancy or out of hours. If I am available, your appointment will be booked via my secretary on and will be charged separately. If the treatment is unsuccessful we normally advise you to book a review consultation, where we analyze the outcome of the treatment and advise you on your next steps. This is booked via my secretary on or the receptionist in the ACU on and is included in your treatment price. In conclusion If you do IVF without ICSI and do not do blastocyst culture or embryo freezing you will pay: 3450 for the IVF cycle + approximately 1500 for drugs This does not include your initial consultations and investigations. The treatment cycle starts when you start taking the medication and finishes when you do the pregnancy test to see if it has worked or not. If you do ICSI you will pay an additional fee, as outlined in the price-list and if you freeze embryos you will pay an extra fee for freezing and storage for one year

7 Cancellation fees If your IVF cycle is cancelled before egg-collection, you pay a cancellation fee of 700 plus drugs. If you have an egg collection procedure and there are no eggs, or if the eggs don t fertilize or the embryos don t survive, you pay the whole fee ( 3450 plus drugs) for your treatment as outlined above. The purpose of the cancellation fee is to cover the work of all the people who were involved in your care, up to the point that it was decided to abandon this cycle. This includes, scanning, medical advice, nursing input, administrative and secretarial work and laboratory work. The nurse consultation Before you start treatment you will need to make an appointment to meet a nurse at the ACU. Please phone ACU on to book this appointment, which will need to be during working hours. Both you and your partner will need to attend. The nurse will have instructions from me about your treatment. If she has any queries she will ask me. In your meeting, she will cover practical aspects of your treatment, will get copies of your passports, will keep copies of your infectious screening, will ensure that you have your drugs and know how to use them. She will also ask you to fill in and sign a number of forms that are necessary for the Human Fertilization and embryology authority (HFEA). The forms that you have to fill in The nurse will ask you to fill in and sign a number of forms for the HFEA (Human Fertilization and embryology authority). These include: 1) Welfare of the child forms for both 2) HFEA forms for egg and sperm use for both 3) Consent to IVF. 4) Consent to ICSI if necessary 5) Consent to blastocyst culture 6) Consent to freezing of spare embryos All these forms will soon be uploaded on our website in the Chelsea Westminster Section and you will be able to download them and fill them in before you see the nurse.

8 Your infectious screening All fertility Units are legally obliged to have up to date records (within 24 months) of screening for Hepatitis B, C and HIV for both of you. My secretary will offer to organize these tests for you, and you can have them done at the TDL laboratory, 55 Wimpole Street, London, or a nurse can visit you at home. The name of the profile that you need to order is FFL1 (Fertility for life 1). Alternatively, during the nurse consultation, the nurse will offer to do these tests for you. These are charged separately. If you have already done these tests you will need to bring copies of the results to the nurse, for filling in your hospital records. Please don t ask me to chase up your blood results for you (which you think you may have done at your last medical assessment at your work, or you GP etc. etc. etc. I simply don t have time to do this for you. I am very sorry. You will NOT have an egg collection if all the test results below, up to date within 24 months on the day of egg-collection, are not available and filled in the notes. This is absolutely clear. We need: Hepatitis B surface antigen for both Hepatitis B core antibody for both Hepatitis C antibody for both HIV 1, 2 antibodies for both Rubella immunity test (IgG) for the female partner. Please, note that for Hepatitis B we need both the core antibody (HBcAb) and the surface (or Australian) antigen (HBAsAg). The GPs occasionally do only the Hep B surface antigen but not the Hep B core antibody. Sometimes they do the surface antibody but not the surface antigen. So please check that you do have ALL the tests we need. If you are not sure, please liaise with the ACU nurses. Your prescription You need to ensure that you have the drugs that you need for the treatment. You have 2 options: Option1: You get a prescription when you see the nurse in the ACU and collect your drugs from the pharmacy at Chelsea Westminster. Ption 2: You have them delivered to your home by Healthcare at home. This can be arranged by contacting my secretary on My secretary will arrange for drugs to be delivered to your home address directly from Healthcare at home. We need at least 24 hours notice during working hours. However, if you

9 need more drugs at very short notice (i.e. the same day), or if you run out of drugs during a WE or bank holiday we wont be able to help you. Therefore you need to think ahead. As we order directly from Healthcare at Home, we have to send you the full prescription. We cannot be sure exactly how long it will take for your ovaries to be ready for egg collection. For this reason, we tend to send slightly more so that you don t run out of drugs the last minute. Unfortunately we cannot offer you a refund if you don t use the drugs for whatever reason. Once the drugs are delivered to you they cannot be returned or used for another patient. Don t run out of drugs out of hours (especially the Weekend) I will leave it up to you to ensure that you have the drugs that you need. Booking scans and appointments To book the scans during the IVF cycle you call the ACU reception on The scans are done by the sonographer between 830am and 1230pm Monday to Friday. After the scan you ee one of the ACU nurses and usually you have a blood test. The nurse will liaise with my consultant colleague or me and she will call you in the afternoon with instructions. Duration of appointments A treatment scan appointment as part of your IVF cycle is an appointment to do a scan. It lasts for about 10 min. Unfortunately we cannot offer you a full consultation about your possible next steps should the treatment be unsuccessful, various things you heard or read on the Internet, etc. when you come for a treatment scan. There will be other patients waiting for a scan after you. If you have other issues to discuss then you need to contact my secretary on and book an appointment for consultation and scan. This consultation will be charged separately. Your egg-collection and embryo transfer The nurses will give you specific instructions about the timing of your Ovitrelle injection and your egg eggcollection. After your egg-collection you will receive verbal and written information. Before you leave the ACU the nurse must talk to you about going home following egg collection. You will start using progesterone pessaries or cream the same night, according to my instructions. Occasionally we use intramuscular injections of progesterone.

10 The day after the egg collection you will be contacted by the embryologist, usually by mid-day. He/she will let you know whether any eggs have fertilized or not, how many embryos you have and he/she will give you a provisional time for embryo transfer. The earliest we do an embryo transfer is 2 days after an egg collection. The latest is 5 days after the egg collection. The average is 3 days. The reason for prolonging the culture of embryos beyond day 3 is to decide which embryos are the best ones among a number of good embryos which seem similar in quality. Deciding how many embryos to transfer and when to transfer them The day after the egg-collection the embryologist will call me to tell me how many eggs have fertilized (if any) and discuss the quality of the embryos and possible time for embryo transfer. Then he will call you and discuss the same with you. We normally check your embryos daily and decide when the best time to transfer them back is. Usually this is day 3 or day 5 following egg-collection. The final decision about the number of embryos to transfer will be made by you. We will offer you information and advice. If you have spare embryos that are suitable for freezing the embryologist will inform you. You have to tell them if you want your spare embryos to be frozen. After the embryo transfer After the embryo transfer you will take your progesterone supplements for two weeks and then do a urinary pregnancy test. You will call the nurses on and leave a clear message with your name and date of birth as soon as you have the test result. If the pregnancy test is positive: You will need to continue using progesterone supplements for a few more weeks and book a pregnancy scan via the ACU reception on The scan will be 2-3 weeks after your positive pregnancy test and is done by the sonographer. If you need a repeat prescription for progesterone you can collect it from ACU nurses giving some notice (ideally 48 hours) and collect the drugs from the pharmacy at Chelsea Westminster. Alternatively, you can contact my secretary and ask for a repeat prescription to be sent to your home address but we need at least 48 hours notice to do this. For such a small prescription (a box of cyclogest pessaries, for example) I much prefer that you collect it though the nurses in the ACU. I find that I get flooded with requests for repeat prescriptions or similar minor issues, all of which tend to be urgent, and I simply cannot catch up! If you have abdominal cramps, or blood spotting, or other issues, while waiting for a pregnancy test, you will call the ACU nurses and receive advice directly from them.

11 If the pregnancy test is negative: You will stop using the progesterone supplements and will have a period. You will call my secretary or the ACU receptionist and book a review consultation no earlier than 2 weeks after your negative pregnancy test. During this consultation we will review your treatment cycle and plan the next steps. In my experience it is better if you leave the review for at least 2 weeks after the negative pregnancy test, in order to get some rest and have time for quiet reflection before we meet again. You should expect the normal cycle of psychological and physical tiredness, disappointment, depression, sometimes guilt, anger etc. before you can have a more balanced view of things again. During this period you should try and get some rest and support each other. Seeing the counselor or accupuncturist often helps during that time. You can arrange an appointment to see the counselor by contacting the ACU reception on or Time off work You will need to be off-work the day of egg-collection. You may opt to be off-work for a few days following egg-collection, as you may feel some discomfort; however this is not usually necessary. After the embryo transfer you will need to avoid swimming, coffee and alcohol, as well as strenuous exercise. Some patients arrange to take a holiday after the embryo transfer. In the past we have received requests from patients to give sick certificates for a few weeks prior to treatment for preparation and a few weeks afterwards to recover. Unfortunately we cannot do this unless something catastrophic happens and you are really poorly for all this time (which is extremely unlikely!) Who will carry out your procedures The procedures (egg collection, embryo transfer, cervical assessment, endometrial scratch etc) will be carried out by either me or one of the other doctors who work in the ACU. If you need an absolute guarantee that I will always do your procedures personally, then I am afraid you should NOT start treatment with me as I CANNOT offer this promise. Information leaflets There are several leaflets available at the ACU, covering various parts of your treatment (egg collection, embryo transfer, ICSI, assisted hatching, multiple pregnancy etc., which you can read. However, when there is any discrepancy you will do what I have advised you or you will ask me in clinic.

12 Support for you: Who to contact and how during the treatment For booking scan appointments for treatment you will call the ACU reception in For initial and follow up consultations you will call my private secretary on or the ACU reception on During normal working hours, if you have queries regarding your ongoing treatment you can contact the ACU nurses on You will leave a clear message with your name and contact number and they will get back to you by end of business the same day or the next working day. The nurses can assist you for queries about your consent forms, injection technique, blood tests and similar issues that refer to the practicalities of the treatment. You should mention that you are a private patient of Mr. Nikolaou. If you have a serious problem out of hours during your IVF treatment cycle, or you feel very unwell, you must contact the nurses on the emergency number on The nurse will advise you and may contact me or my consultant colleague to discuss if necessary. Please note this option is only for genuinely urgent and important issues that cannot wait until the next working day. If you need more than advice, the nurse will advise you to go to Accident and Emergency at Chelsea and Westminster hospital and be seen and admitted on the NHS if necessary. If you have an emergency and cannot get hold of the nurse for whatever reason then you must go to A & E at Chelsea and Westminster hospital The early pregnancy care (scans, consultations etc after the positive pregnancy test) is NOT part of your IVF cycle. Please go to our website at the Chelsea and Westminster page and read the instructions. Finally: As you are aware, infertility and fertility treatment can be emotionally draining. It is the same for the doctor and the nurse who deals with many infertility cases at the same time. We do need time to recharge and recover, in order to be able to help you. So, yes, call us in an emergency, but please save the other issues for when we meet in clinic, rather than by ad-hoc s and messages. Often patients come to me for a consultation but then remember something else, or hear things from friends or the Internet and ask me, via my secretary, to call them to discuss. Similarly, we receive s with lists of questions. Unless it is a real emergency, I am sorry but I will not call you to have a chat and I will not answer medical questions by e - mail. If this is unacceptable to you, I am very sorry but you may prefer to see

13 another doctor. I am not happy to offer medical advice by or text messaging or ad-hoc telephone calls. The best time to discuss your treatment with me is in my clinic, where I have your medical records, and I am physically, mentally and emotionally available to deal with your issue. Please bring your questions with you to discuss when you come to clinic. In our website we explain our normal process, particularly that more than one clinic appointment are often necessary before you are eventually ready to proceed with treatment. You must not embark on treatment, especially IVF or surgery, if you don t fully understand what you are doing, why you are doing it, and you don t feel ready and happy to proceed. If things don t go according to plan This is a journey that we travel together. On our website you will see out philosophy. I would also advise you to read the poem Ithaca by K. Kavafi. Even if there is an apparent set back, there will be something positive to take from it. My intention is to help you as much as I can, but I need you to have faith and trust me otherwise the treatment may be compromised at some level. If you have any concerns please talk to me about them openly when we meet. Often patients write to me out of hours, typically on a Saturday or Sunday night, on Christmas day etc., and expect me to get back to them immediately. I will get back to you when I am ready. You may need to be a little patient unless it is a real emergency. I try my best to help but you must also understand that I can get tired both physically and emotionally. I do care. Counseling Fertility treatment can put a lot of strain on individuals and relationships for a number of reasons. More so if it is not successful. You can always speak to me. Every fertility Unit has the obligation to offer independent counseling from qualified fertility counselors. You can access this by contacting ACU reception on and ask for the contact numbers of the fertility counselors. You can also visit our website and go to the page: infertility investigations and treatments/support for you

14 Copy of your records If you need a copy of your IVF records you will contact ACU reception directly ( ). My private secretary is not based at the Hospital and does not have do not hold any other records about you apart from any letters that we have already sent to you. If you need my secretary to send you other packages with old letters etc., there will be an admin fee for at least 50 to cover the time of the secretary and expenses. If, for example, you are moving to another country or clinic and you need me to write a detailed report covering all your consultations and treatment, then an invoice will be raised to cover my professional time. The current rate is 180 per hour. However, my private secretary will not be able to copy your NHS- funded IVF notes. You will need to arrange this yourself by contacting the ACU reception. If you want to see me at Women s wellness centre, or elsewhere, having had NHS treatments at Chelsea Westminster previously, you will need to bring a copy of your NHS records with you at your appointment with me. My private secretary does not have access to your NHS records or test results and cannot photocopy your medical motes or transfer them out of the hospital. Similarly, if you have done blood tests and scans at Chelsea Westminster as an NHS patient, for example tests for Hepatitis and HIV, you need to contact the NHS reception and arrange for copies of your tests to be sent to you before you see me in any other location apart from Chelsea Westminster. My private secretary does not have access to your NHS records and cannot request them on your behalf, as they are confidential records of yours. Plan A and plan B Fertility treatment is often a long journey. You need to have a strategy that includes pre-treatment advice and preparation, ongoing support (including counseling and alternative therapies), the treatment itself and a plan B. Pre-treatment and co-treatment It is important to optimize your weight and health before the treatment. In some cases, I may also put you on medication to prepare your ovaries for a few months before we actually start IVF. You can also find information n our website under infertility treatments/support for you Plan-A Is what treatment we are going to try, how many attempts each and when. Usually I recommend that you plan at least 3 IVF attempts, even if you eventually only need one! This creates a psychological safety net that is very useful in case the first cycle is cancelled or is not successful. Having the net underneath increases the chance of the treatment being successful.

15 If your first IVF cycle is unsuccessful you must book a review consultation with me before you plan your next step. This is booked normally via my secretary on or the ACU receptionist on Let things cool off a little. You normally want to discuss with me immediately once your pregnancy test is negative. This is understandable. You need reassurance that you can still have babies and your fertility has not reached a sudden and irreversible end. However, it is far better to wait for a couple of weeks before we actually meet. This will allow me to consider your case, to receive the details of the laboratory observations on your gametes and embryos, and you to have some perspective. There is huge variability in all human characteristics and your ovarian response to stimulation, quality of embryos etc. will vary from cycle to cycle. The cumulative success of IVF treatment increases in the first 4-6 attempts. We normally recommend a break of 2 months between attempts, to let you recover both physically and emotionally. Plan B is what happens if all treatments fail. You need to make an appointment to discuss with me about your plan B, including being fertile without necessarily having your own biological children, or egg donation. Having considered this possibility helps people cope better with fertility treatment. Where can you see me For all private consultations you should call my secretary on Chelsea/Westminster private outpatients, 4 th floor, 369 Fulham road, London SW10: Appointments are Wed pm 2-5 and 6-8. Please, don t e mail me directly to try and book an appointment! I don t carry my diary with me and cannot do this for you. You need to call my secretary and tell her what you need: For example, if you need a consultation, book a consultation. This normally lasts for 60 min for new and 30min for follow up. If you need longer time, you need to book a long consultation If you need a scan, book a scan (not all rooms have a scanning machine and we need to know what you need in order to book this). If the scan is part of an ongoing IVF cycle for which you have paid a package fee, you need to clarify that it is a treatment scan, part of the IVF cycle, otherwise my secretary will book the wrong slot and you will receive a bill!

16 If you need a test for your fallopian tubes (HysoSY), you need to explain this to the secretary. If you expect me to have previous records for you or results of tests, you need to mention it to the secretary so that it can be organized for you. I hope the above information is clear and the treatment will run smoothly for you. Good luck! DIMITRIOS NIKOLAOU and the team at Fertility for life.