Fertility FAQs (2)
A number of factors have been shown to reduce the quality of eggs and sperm, so there are a number of things you can do to minimise this risk, and provide the best conditions possible for the development of your reproductive cells. These types of cells are created over a prolonged period of time, so the modification of lifestyle must be considered as a long term investment. You can find out more in our Lifestyle Advice section.
You need four things to get pregnant:
- you need to produce an egg (ovulation),
- you need good quality sperm,
- then the egg and the sperm need meet and fuse (fertilisation).
- the resulting embryo must then implant in the womb.
It sounds relatively simple, but in fact hundreds of synchronised hormonal and physical events must take place and there are many steps where things can go wrong.
“Infertility” is defined as the failure to get pregnant after one year of having regular, unprotected intercourse.
Around 1 in 6 couples have difficulty in conceiving, and this proportion is increasing, largely because women are starting their families later in life and because sperm counts are falling. However, with the appropriate help, the vast majority of couples can realise their dream.
There are many reasons why you might be having difficulty getting pregnant but broadly they are due to problems of ovulation and egg quality, problems of sperm quality, problems with the fallopian tubes, or a combination of these.
COMMON EGG PROBLEMS:
- Polycystic ovary syndrome (PCOS link to A-Z).
- Being over- or underweight
- Medications that affect ovulation
- Increasing age. Unfortunately, as a woman gets older, the quality of her eggs decreases.
COMMON SPERM PROBLEMS:
It is thought that environmental pollutants are resulting in increasing sperm problems. As a result, we are seeing more men with:
- Too few sperm
- Not enough motile (active) sperm
- Minor genetic problems that affect sperm counts and quality
- Genetic problems or past infection.
COMMON FALLOPIAN TUBE PROBLEMS:
- Past pelvic infection
- Past pelvic surgery
Endometriosis is a common condition where the cells that line the womb (and bleed each month with a menstrual period) occur outside the womb. Even mild endometriosis can have a negative effect on a couple’s fertility.
In a proportion of couples we can’t find an obvious cause and this is termed “unexplained infertility”. It doesn’t mean that there is nothing wrong, it just reflects our current state of knowledge and it might be due to a subtle problem with one of the hundreds of things that are required for successful conception and implantation
Female fertility FAQs (2)
Cyclogest pessaries contain the active ingredient progesterone, which is a naturally occurring female sex hormone. They help to support early IVF pregnancies. They are used twice daily, once in the morning upon wakening and once at night before going to bed, and they are inserted either into the vagina or rectum (back passage). You should lie down for approximately 30 minutes after inserting a pessary, allowing them to melt and the progesterone to be absorbed into the bloodstream. It is normal to find that some of the excess pessary is discharged; your body absorbs what it needs.
Your level of AMH (link) helps to predict how well your ovaries will respond to stimulation during an IVF cycle. It can be used to tailor the stimulation drugs to an individual patient and can predict which patients may expect low or high egg numbers and even patients at a higher risk of ovarian hyperstimulation syndrome (OHSS) (Link to OHSS in A-Z). Patients with a low AMH or a low antral follicle count do have lower pregnancy rate but the severity of this reduction is age related, with patients ≥39 yrs have a significantly lower chance of pregnancy than patients with the same AMH who are less than 39yrs. Pregnancies have been reported in patients with very low, or barely detectable AMH levels. Patients with a low AMH (less than 3.08 pmol/l) also have an increased risk of failed fertilisation across all age groups.
Male fertility FAQs (2)
Sperm are produced in the testes. Sperm develop inside very small tubules in testicular tissue (seminiferous tubules) and then move along a network of tubes to a holding place (the epididymis) before ejaculation. In the average man with a normal sperm count, the testes produce thousands of sperm every second, but it takes three months for these to become mature and be ready to be ejaculated.
There are several ways to test male fertility, but these depend on the outcome of the initial semen analysis. For men with normal numbers of sperm with good motility we don’t typically offer further tests, as their results don’t influence treatment or treatment outcomes. For men with abnormal sperm results, we follow a pathway which may involve blood tests, genetic studies and testicular exploration. The semen analysis is the most important test, and the place to start.
Sperm sample FAQs (6)
This will depend on the reason you need the procedure. Men who have no sperm in their ejaculate due to a blockage have a higher chance of retrieving sperm than men who have testicular failure. Retrieval rates range between 25-75% but please speak to your doctor at your consultation for a more accurate estimation based on your own diagnosis. You can find out more on the SSR treatment page. (link).
We will speak to every couple on the day of treatment about their sperm quality and discuss the best treatment option. If the sample is poorer than expected, we may need to use a procedure called ICSI (link to A-Z). This is where we inject a single sperm into each egg to help maximise fertilisation rates, and can be done with very small numbers of sperm. If numbers are extremely low or we fail to find sperm on the day of treatment, we may be able to do a surgical procedure (SSR – link to treatment page) to recover sperm for treatment.
If you are concerned that you may struggle to produce a sample on the day of treatment please speak to an embryologist about freezing (vitrifying) a sample prior to treatment which can be used as a back-up: this can help to alleviate stress on the day. If we do not have a semen sample on the day of treatment, we may be able to extract sperm surgically, or vitrify the eggs to commence treatment at a later date.
For the best result, you must abstain from ejaculation for a minimum of 3 and a maximum of 5 days (See: Can we have sex during treatment or before a sperm sample?). Wash your hands and genitals before you produce the semen sample. You must tell the clinic about any illness or medication taken in the last three months, as these things can affect your semen quality, and the advice you’re given after the analysis.
If producing a sample at the clinic is unsuitable or unsuccessful, or if you are concerned that you may have difficulties, please speak to a member of staff about alternative arrangements. It may be possible to produce a sample at home. You will be provided with an appropriately labelled sterile pot and a sealable plastic specimen bag for transport. You must ensure that the sample can be transported at a temperature between 20oC – 37oC (we suggest close to your body/ inside jacket pocket) and within 1 hour of production. You will also need a form to state that the sample is your own. You must inform a member of staff if the whole sample was not collected. Spillage of the sample can affect the results and subsequent treatment plans.
It is best to produce the semen sample on-site at the clinic. A discreet and quiet room is provided and ‘embryo-friendly’ lubricant is available. We will do our best to make you comfortable and relaxed; you may wish to have your partner with you, but please be aware that this isn’t always possible. You must inform a member of staff if the whole sample was not collected. Spillage of the sample can affect the results and subsequent treatment plans.
Receiving Donor Sperm FAQs (2)
The embryology team will advise as to how many straws or vials of sperm will be required for your treatment cycle.
We have our own donor bank and can often match donors to patients to ensure treatment can be done as quickly as possible. We can also obtain donor sperm from sperm banks both nationally and internationally. There is no waiting list for purchasing donor sperm from international banks, though it does take around 6-8 weeks for the process of matching and importation to take place For more information about donor sperm, click here (Link to receiving Donor sperm.) The embryology team will advise as to how many straws or vials of sperm will be required for your treatment cycle.
IVF/ICSI Treatment FAQs (4)
Many couples remain intimate during treatment and this is perfectly fine in most cases. There are times when unprotected intercourse is best avoided and this will be clarified during treatment as it is different for different couples.
One occasion when we can give general advice is before a sperm sample is provided for analysis or treatment. It is important to avoid ejaculation for a few days as this affects the result and both the number of sperm and their motility. The highest number of sperm and best motility are typically seen after a man has abstained for between 2 to 7 days. Abstaining for longer than this may increase the number of sperm but the proportion of sperm still ‘swimming’ falls. In contrast, ejaculating every day may increase sperm motility but the numbers will be lower. The 2 to 7 rule is the best compromise therefore between concentration and motility.
The standard course of drugs for an antagonist cycle is 14 days, over 90% of our fresh cycles are now antagonist (mild) cycles. If it is necessary to have a long cycle, the drug course lasts around 4 weeks. After this you will have your egg collection procedure. 3 or 5 days after your egg collection you will generally have your embryo transfer. This is the standard time taken for IVF cycles but individual circumstances may alter these timings slightly.
IVF (In Vitro Fertilisation) is where a high number of (prepared) sperm are added to a dish containing the eggs and the sperm are left to swim to the eggs on their own. The sperm & eggs are left together overnight and checked for fertilisation the following morning.
ICSI (Intra Cytoplasmic Sperm Injection) is where a single sperm in injected into an egg by an embryologist. This technique may be used if the sperm concentration or motility are low or if poor fertilisation had been achieved previously with IVF.
You can read about treatment protocols on the IVF treatment page.
Blastocyst FAQs (2)
Approximately 40% of embryos will reach the blastocyst stage. Those at a compacting or cavitating stage (the stage before the blastocyst stage) can still be transferred but do have a lower chance of achieving a pregnancy. There is a small chance that all of patients’ embryos may stop developing at the embryo stage, this happens in approximately 2% of blastocyst cycles and results in the embryo transfer been cancelled.
‘Blastocyst culture’ is the term commonly used to describe the culture of embryos until they are five days old. A blastocyst has a large number of cells and consists of two distinct cell types. Around 40% of embryos will reach the blastocyst stage and those that do have a higher chance of implanting once transferred.
Blastocyst culture is usually recommended for patients with a good number of fertilised eggs (3-4), where it will be difficult to choose the best quality embryos at an earlier stage of development, allowing the best embryos to select themselves. This will be discussed with all patients on the day of egg collection and again on the day of fertilisation.
Embryo Transfer FAQs (6)
Success in IVF treatment is determined by a large range of factors. Your doctor is the best person to advise you about your chances of success, as they have all the information about your treatment programme. You can find the latest results from this clinic, and comparisons to national and nearby success rates here (our success link).
The Primo Vision Time Lapse System consists of a series of specialist cameras that are housed inside an incubator. Photographs of patients embryos are taken every 20 minutes and these are linked together to form a video sequence of embryo development. Time Lapse can be used to gain additional diagnostic information about the development patterns/timings and quality of a patient’s embryos. Primo Vision also has a built in algorithm which is a mathematical formula that helps the embryologist select the best embryo for transfer. Primo Vision can be used in IVF & ICSI cycles and can be used in combination with blastocyst culture.
Patients who may particularly benefit from this technology include those with; previous failed attempts at IVF/ICSI, known poor embryo quality/low fertilisation rates, previous miscarriages, cycles using surgically retrieved sperm samples.
Embryos which are not transferred can be frozen if they are of a suitable quality. At the time of embryo transfer the Embryologist will discuss with you the quality of the embryos for transfer and any remaining embryos and will advise you if these meet the criteria for freezing. On average we freeze for approximately 25% of patients.
EmbryoGlue ® is a culture medium that is used to transfer your embryos back to the uterus. It is unique as it contains a high concentration of hyaluronan, a substance which is naturally occurring in the uterus & known to be involved in implantation. You can learn more about EmbryoGlue on in our patient info page.
If you have been recommended for SET you are a patient with a high chance of achieving a pregnancy from IVF treatment. A high chance of pregnancy is accompanied by a higher risk of twins, and a higher risk of complications, if we replace two embryos. Visit the Single Embryo Transfer page in Patient Info for more information… (link)
At the early stage of development when an embryo is 2/3 days old, embryos are graded based on the number and quality of their cells and amount of fragmentation present. Each embryo is given a grade on a scale of 1-4, 1 is the highest grade and 4 is the lowest. Embryos graded 1 or 2 are suitable for freezing.
Blastocysts are assessed by observing their expansion status and by taking into account the quality of the two distinct cell types within the blastocyst. Blastocysts will be graded from A to C, with A been the highest grade. Blastocyst that are grade A or B are suitable for freezing.
Frozen Embryo Transfer FAQs (3)
Our aim is to give you the best chance possible of pregnancy with each frozen embryo replacement cycle. Not all embryos have equal potential to form a pregnancy and each will be affected differently by the freeze and thaw process. This may not be immediately clear to us after thawing. For this reason we usually thaw more embryos than you would like to have transferred back to the uterus. This gives the embryologist a chance to select the best quality & highest surviving embryos from a group and therefore gives you a higher chance of pregnancy. If you have embryos frozen at the day 2/3 stage of development we will usually recommend thawing at least 4 and culturing them in our incubator until the blastocyst stage to help us choose the best embryos. If you have embryos frozen at day 5 of development (blastocysts) we will usually recommend thawing at least one more than you wish to have transferred. Blastocysts are thawed and transferred back to the uterus on the same day.
Frozen embryos are stored in liquid nitrogen at a temperature of -196°C. This means they are held in a suspended state and do not deteriorate with time in storage.
We find approximately 80% of frozen embryos survive the freezing/thawing process. This can vary depending on the stage of development that the embryos were frozen and an individual patients’ embryos susceptibility to the process.
Vitrification FAQs (4)
Frozen embryos are stored in liquid nitrogen at a temperature of -196°C. This means they are held in a suspended state and do not deteriorate with time in storage.
We will send you a letter about 6 months before the period of storage is due to end. This will outline your options and include a consent form for you to return to us. If you don’t reply to this first letter promptly, we will send you a second letter, attempt to contact you by phone and contact your last known GP.
Your choices at the end of the storage period are: to use the embryos/sperm for treatment before the end of the consent period, extend storage, to discard the embryos/sperm if you no longer plan to have treatment, or to donate to another couple or to research (applicable in some circumstances).
It’s really important that we stay in touch with you if you have frozen embryos/sperm in storage. We will contact you when your embryos/sperm near the end of the period of storage you have consented for. We have found that if patients consent to storage for longer periods it is more difficult to contact them when this period ends and it is important for us to find out your wishes at this time. Please remember to let us know of any address changes.
There are many reasons why a patient may wish to consider egg freezing. This may be prior to having chemotherapy treatment or treatment which may render them prematurely infertile. We also offer egg freezing for other women, such as those who may wish to preserve their fertility and have children later in life. Please visit the Fertility Preservation page for more details.
Donor FAQs - Sperm (3)
After your semen analysis your sperm will be frozen and thawed. This will show the survival rate of the sperm once thawed. You will then be contacted and informed whether you are initially suitable to be considered as a donor
Yes, the Human Fertilisation and Embryology Authority (HFEA) states that up to 10 families can be created from each donor. You may choose to restrict the number of families to less than 10 if you wish. There is more information available regarding this on the HFEA website: http://www.hfea.gov.uk/potential-donors.html.
If a child is born as a result of your donation, they are able to find out detailed information about you once they reach 18 years of age and this information could lead to them identifying you. There is more information available on this subject on the National Gamete Donation Trust website http://www.ngdt.co.uk/become-a-sperm-donor
Clinic & General FAQs (8)
It is possible to transfer your frozen embryos/sperm from a clinic outside of the UK to Nurture or vice versa. The HFEA stipulate that certain criteria must be met in order to fulfil conditions for a general license to transport gametes/embryos. If conditions under the general license are not met, we would then apply for a special license which would allow us to transfer samples between clinics. An external courier will take care of the actual transportation of your gametes/embryos to or from Nurture in conjunction with the receiving clinic. More details about this can be found on the HFEA website.
Yes, this is something that can be arranged between the two licensed centres. You will need to complete consent forms for the transfer to take place and decide whether to use a specialist courier or whether to transfer the samples yourself using a dry shipper hired from the Unit.
Please bear in mind that at Nurture we do not recommend transferring vitrified embryos or blastocysts between Units. These embryos are “frozen” in very small volumes of media that are very susceptible to temperature changes and therefore it is safer not to transfer these. It may however be possible to have all of your investigations at a Unit in close proximity to your location and then travel for your embryo transfer procedure.
Unfortunately despite falling pregnant, either naturally or after fertility treatment, some couples experience the tragedy of a miscarriage. In the vast majority of cases there is nothing wrong and subsequent pregnancies proceed uneventfully but miscarriage can recur. One reason for this is an abnormality of the shape of the womb known as a “uterine anomaly”. 3D ultrasound allows us to ensure the uterus is normal or to detect these anomalies with absolute confidence allowing us to offer reassurance or surgery where appropriate. We also check the blood flow to the womb which may relate to repeated unsuccessful IVF treatments.
Yes, we receive donations from women who are prepared to do something amazing by donating some of their own eggs for use in our fertility programme (altruistic egg donors) or donations from someone known to the recipient patient (known egg donors). Now, there is also the option for embryo donation by patients who have successfully completed a course of IVF but who still have viable embryos available.
Apart from adhering to HFEA guidelines the clinic has few restrictions on who it will accept, the main one being an upper age limit of under 44 with your own eggs or under 55 using donor eggs. If after the initial consultation we do not feel that it would be in the best interests of your own health to proceed with IVF we will talk this through and provide full counselling and support to help you decide on the next step.
The clinic’s success rate has continued to improve over recent years and is now recognised as being excellent. This success reflects the experience and quality of the Embryology Team and the dedication and skills of the doctors, nurses and administration staff. For both IVF and ICSI we exceed the national average in each of the age groups up to women of 41 years of age. To see our current success rates click here.
The key to choosing the right clinic is to choose the one that feels right for you. We understand that undergoing fertility treatment is a highly stressful and emotional time and we put your physical and emotional well-being above all other considerations. The clinic is staffed by a committed and understanding team of medical and nursing professionals who have the experience, knowledge and desire to provide you with the best chance of a successful outcome at the end of your treatment.
There is no standard fee for fertility treatment as there are a number of complex factors that will vary for everyone, such as the amount of medication needed. For a detailed breakdown of the pricing structure for the different stages of the process and the auxiliary services available, as well as a list of price examples, please visit our Prices section.
Before treatment (4)
Generally, the presence of a hydrosalpinx means that the Fallopian tube is damaged. The fluid within a hydrosalpinx tends to leak back into the womb and reduces the chances of conception both naturally and after IVF treatment. Removal of the tube is recommended as this has been shown to almost double the chances of pregnancy.
A fibroid is a benign (non-malignant) tumour or overgrowth in the muscle layer of the womb. They are very common and can range in size from very small (less than the size of a pea) to very large (the size of a grapefruit). Depending on the location of the fibroid, surgery may be required to remove it.
An endometrial polyp is a benign (non-malignant) tumour or overgrowth of the lining of the womb. They are very common and can be solitary or multiple. The majority of polyps do not cause any problems but in a small number of cases they may interfere with implantation and increase the risk of miscarriage.
An ovarian cyst is simply a fluid-filled sac. Cysts are often solitary but can be multiple and affect both ovaries. There are many different types of ovarian cyst all of which require different treatment. In certain circumstances it may be necessary to remove or aspirate the cyst before commencing treatment.