INFORMATION FROM THE PETERBOROUGH FERTILITY CLINIC Problems with conceiving are a common and distressing problem affecting at least one in six couples. If you have been handed this sheet it is likely that either you or your doctor suspect that there may be a problem in this area and we very much hope that we can help to resolve this situation. Infertility occurs equally in men and women and can occur readily in those who have had or been responsible for a previous pregnancy. Quite often we discover a clear reason but sometimes there is a combination of problems or no definite reason is found. IMPORTANT INFORMATION The Department of Health advises all women who are actively planning a pregnancy to take a 400 microgram folic acid tablet daily as this has been shown to reduce some birth defects. These can be bought from supermarkets, health food shops or chemists. It is fine to take folic acid every day for the whole time you are trying for your baby. Women with diabetes or who are taking medication for epilepsy, or have had an infant with a neural tube defect require a higher dose of Folic Acid (5 mg per day). Your General Practitioner (GP) will need to prescribe this. It is very important for the woman to work out her cycle lengths over the last year or so. To work out the cycle length, count from the first day of bleeding in one cycle to the first day of bleeding in the next cycle e.g. if a period starts on the 1 st August and then another period starts on the 30 th August this would be a 30 day cycle. Even if there appears to be no pattern to your bleeding please still calculate all cycle lengths. We would normally expect that ovulation is occurring (an egg being released) if the cycle length is between 25 42 days. It is not unusual for women to bleed only occasionally, e.g. every 70 or 90 days. Please still calculate the frequency of the bleeds. Please bring a list of all cycle lengths with you to any future appointments (at your GP surgery or the Fertility Clinic). The following information has been shown to significantly improve fertility. For the majority of couples if you make the necessary changes and time intercourse to the fertile time pregnancy should happen. Weight At your first appointment we usually do the height and weight of the female partner. For many women if they become underweight or overweight this can prevent ovulation (an egg being released). Being underweight or overweight will lower your chances of getting pregnant and increase the risk of certain problems in pregnancy. There is a greater chance of miscarriage if you are overweight. Before making your first appointment, if you have very irregular 1
cycles or no cycles, this could be an excellent opportunity to see if a change in your weight will allow a more regular ovulatory cycle and pregnancy! We have found for the vast majority of women, if they are overweight and lose 10% of their weight, many will start to have a spontaneous ovulatory cycle. It appears it is the weight change involved that allows ovulation, not necessarily being at the ideal weight. Once cycles commence (25-42 days) most couples will have a baby naturally and never need medical treatment. Quit Smoking Smoking has been linked to infertility and miscarriage. Smoking leads to an earlier menopause (up to two years earlier!) and lower sperm counts. The NHS offers plenty of free help and support for people who want to give up smoking. Evidence shows that getting professional advice and using nicotine replacement can quadruple your chances of stopping for good. To contact Peterborough Stop Smoking Tel; 0800 376 5655 or text them on 07884 313 482. Website www.peterborough.nhs.uk/stop Alcohol Just nine units of alcohol a week can mean that it can take you twice as long to conceive a unit being a small glass of wine, half a pint of normal strength beer or a small glass of spirit. Drinking too much alcohol can also increase your risk of miscarriage and will affect the quality of your partners sperm. For men, excessive alcohol intake can have a severe effect on semen quality. Limit yourself to no more than one or two units a night while your partner should stick to less than two or three units. Both of you should try to have a few alcohol free days during the week. Avoid drugs Street drugs such as marijuana or cocaine do affect fertility so it s best to steer clear of them. Some prescription drugs are also not recommended when you are trying for a baby or during pregnancy. Ring the medicines information line to find out if a medication could cause problems conceiving or in early pregnancy. Tel: 01733 677303. Talk to your GP who may suggest an alternative medication The following investigations must be carried out by your Practice Nurse or GP before a first appointment is arranged in the clinic. Please see the check list at the end of this information sheet. HORMONE TESTS Your Practice Nurse/GP can arrange for the woman to have blood taken during the second half of the menstrual cycle. (This test is called a progesterone blood test). This is taken to check that ovulation is occurring. At the same time as checking the progesterone blood test it is usual to screen whether you are immune to German Measles (Rubella). Both of these tests can be done at the same time. If your cycle is irregular your Nurse/Doctor may decide to test the progesterone level on day 21, day 28 and day 35 of the cycle instead of the usual day 21 progesterone. If you do not currently have periods there is no need to test the progesterone levels. 2
Your Nurse/Doctor may also request a set of Baseline Hormones, particularly if your cycles are irregular or if you don t have periods, before you are seen in the clinic (FSH, LH, estradiol, testosterone, TSH, prolactin). If the baseline hormone blood test has already been carried out we will not need to repeat this as long as it has been done at the correct time in your cycle. It is important to have these tests done when your hormones are very quiet. We usually ask for the blood test to be done on Day 1, 2, or 3 of the cycle (the first, second or third day of bleeding). If you experience very long cycles this blood test can be done any time after day 42 of the cycle or if you have no periods the blood test can be done at any point. Where to get blood tests done (available weekdays): Your surgery Peterborough City Care Centre, Thorpe Road, Peterborough (open 07.00 16.00 week days). If any of the blood tests you need fall over a weekend it is fine to come on the nearest weekday. For example, if you need a blood test on the Saturday please have this done on the Friday; if you need it on a Sunday please have the test on the Monday. SEMEN ANALYSIS Usually the male partner will be asked to bring two sperm specimens (it is important the tests are done approximately three months apart) to the laboratory for examination. A full instruction sheet about handing in the semen specimen will be given to you at your surgery. If two samples have already been tested at Peterborough City Hospital you probably will not need to do any more. The sample should be done at home. We usually advise that you produce the sample at approximately 9.00 am at home and bring this into the laboratory before 10.00 am on the day of your semen analysis appointment. There is a very good chance that if you make some of the changes outlined in this information sheet, along with focusing sexual intercourse to the fertile time you may not need to book an appointment in the Fertility Clinic. Along with this information sheet we also recommend that you read the information sheet titled Timing of sexual intercourse for your fertile time and the information sheet about organising a semen analysis test. All of these information sheets are available from your surgery, the most up to date copies can be downloaded from the hospital intranet site which your GP or Practice Nurse has access to. If after a minimum of two to three cycles no pregnancy has happened please see your GP or Practice Nurse to see whether it would be useful to book an appointment with the Fertility Clinic. 3
CONSULTATIONS AT THE CLINIC We always see both partners at the Fertility Clinic. It is important that you both attend so that the Fertility Nurse Specialist or Consultant can ask you both the relevant questions. Please allow one-two hours to visit the Fertility Clinic for your first consultation. 80% of consultations are carried out by the Fertility Nurse Specialists. Information about previous illnesses and operations is very useful. Do not forget to bring a list of all medications you are taking and most importantly the list of all your cycle lengths. INVESTIGATIONS THAT CAN BE CARRIED OUT IN THE FUTURE IF NEEDED There are two different methods of assessing the female partner s Fallopian tubes, either hysterosalpingogram or laparoscopy and dye. At the second appointment the most suitable type of investigation for your situation may be discussed. It is recommended before either test is carried out that the female partner has a screen for Chlamydia. This is a simple test and is much like having a smear test. You may decide, after discussion in the clinic, not to have either tube test done, or perhaps to delay these tests, depending on your situation. After every appointment we usually write to the female partner s doctor to let them know how things are going. It is important that your GP is aware of any treatment/investigations so that he/she can give you the best/safest advice if you should see them at any time. Please let us know if you have any concerns about us writing to the female partner s GP about you both. COUNSELLING Counselling is an important part of your care. It is routinely offered to all couples attending the fertility clinic. The difficulty of conceiving, the investigations and treatment, frequently causes stress and anxiety. Counselling offers an opportunity to explore your thoughts, feelings and beliefs in order to help you come to terms with your present situation. If you would like to meet our counsellor please phone 01733 673766 for an appointment. She is happy to see you at any stage, either before or during investigations, for support whilst having treatment or afterwards. Please leave your name and a contact telephone number when you phone. FOLLOW UP VISITS At the follow up consultation you will both be given the results of your tests and any further investigations will be organised as needed and these will be explained to you. It may be possible at this stage to accurately diagnose the problem causing your infertility, in which case the outlook and any treatments which are appropriate will be discussed with you. In a proportion of couples we do not find an obvious reason. In many cases, particularly that of unexplained sub-fertility, often time will allow a pregnancy to occur. You can be reassured that most couples who attend this clinic will have a baby. Your clinician will be able to give you an idea of the likelihood of this happening depending on your 4
individual results and situation. If, after a specified length of time pregnancy has not happened then some assisted conception treatments may be advised. We hope that this information sheet has guided you through some of the initial investigations and has given you some indication of what to expect when attending the clinic. Please remember that the purpose of the clinic is to help you and if you are uncertain or unhappy about anything please discuss this with the Fertility Nurse Specialists or Consultant. Never be afraid to ask questions. Any comments that you have about our services that can help us improve the quality of the services we provide are welcome. If you have any suggestions please let us know at the time of your appointment or by contacting the Clinical Nurse Specialist Office, telephone number below. We welcome complements as well as criticisms. If you feel that we are not able to help you within the Fertility Unit you are welcome to contact the Patient Advice and Liaison Services (PALS). This Department should be able to help you resolve any problems or concerns quickly and speedily. The PALS team can explain the complaints procedure if needed. If you have any queries please telephone your surgery. Once you have been seen in the clinic, if you have any concerns or questions please telephone the Clinical Nurse Specialist Office at the Fertility Clinic - 01733 673750. Please leave a message and we will return your call as soon as possible. Women s Health Outpatients, Fertility Unit, Peterborough City Hospital, Edith Cavell Campus, Bretton Gate, Peterborough, PE3 9GZ Reference: FPH/194 Clinical Business Unit: Family and Public Health Department: Fertility Author: Fiona Wynn Review Date: September 2012 5
Checklist of investigations that must be done by your GP or Practice Nurse before arranging an appointment in the clinic. Name of test Date test done Result F E M A L E Rubella (see page 5) Progesterone blood test to check for ovulation (see page 5) Baseline hormones (FSH, LH, TSH, estradiol, testosterone, prolactin) ONLY NEED TO DO BASELINE HORMONES IF CYCLES IRREGULAR OR HAS NO CYCLES (see page 5) Chlamydia screen (see page 8) M A L E 1) Semen analysis (to be brought to Peterborough City Hospital Lab) (see page 6) All GP practices in the Peterborough area have copies of our quick reference guide explaining in detail all of the above tests. GP surgeries have access to the most up to date copies of this through the hospital intranet site. 6