First & Only NABH-Accredited Hospital In Nacharam


  24X7 Emergency Helpline : +91 - 88012 33333

Information For You

Before Egg Recovery

Before ready for egg recovery. As usual, the nurses will ring to inform about drug doses.

An HCG injection must be given under the skin about 34 – 36 hours before egg recovery to complete the egg maturation. Along with the time of egg recovery, the nurses will confirm the date and time of HCG injection. It is very important that one should take the injection in the time stated. The next day the one will not need any injections.

From the midnight before the egg recovery, no food or drink is taken.

Slippers, dressing gown, toilet bags are recommended to bring. An embryologist will see the one before discharge. She will need somebody to take home and stay with her overnight.

After the operation, symptoms like feeling tired, having mild abdominal pain, bloated, and vaginal bleeding for some days. Taking rest for a couple of days is mandatory.

It is essential to inform the unit if one is admitted to another hospital after egg recovery.

After Egg Recovery

After the egg recovery being successful, taking rest for a few days is needed. Symptoms like mild period pains, feeling tired are observed. For pain relief, Paracetamol can be used. If one experiences the symptoms (Ovarian hyperstimulation) like vomiting, persistent sickness, thirst, and reduction in the amount of urine, contact the specialists immediately.

The team will explain how and when to use cyclogest pessaries. From the day following egg collection, pessaries should be used, by inserting one pessary vaginally first thing in the morning and the last thing at night.

But on the day of embryo transfer, usage of pessary should be done after the confirmation of embryologists only. And the usage of pessaries is continued till the date of one go for a pregnancy test. If the test results positive, pessary usage is continued until the scan date. If the test results negative, one should stop using pessaries.

In the event of an emergency outside of working hours, please telephone on 8801233333.

 

What time do I arrive?

On the day of the operation, please report to reception. The staff can then tell about the location of the bed.

What do I need to bring?

The one should bring slippers, socks, dressing gowns and toiletries and something to pass the time. Supportive jock strap style underpants should also bring by them, which are should be worn after 48 hours of the operation.

What happens next?

Your consultant and anesthetist will see you before your operation to ask you to sign the necessary consent form and answer any final questions you may have.

How long do I need to stay? 

The team will test after the operation to ensure that you are fit for getting a discharge. Your condition will be checked by one of the IVF medical or nursing team to see you have sufficiently recovered from your anesthetic. We would need to know that you have passed urine comfortably, have been able to eat and drink without any nausea or vomiting, and that you can walk steadily without assistance. You will not be able to drive after the operation so please make sure you arrange for someone to take you home. Please take careful note of the following advice for after your discharge from the hospital.

Any Precautions to be taken after the operation? 

Although you will probably feel fine, judgment is impaired after an anesthetic, therefore do not drive any motor vehicle, ride a bicycle, or operate any machinery including domestic appliances within 24 hours of the anesthetic. You should be driven home by your partner or another companion.

What should I expect following surgical sperm recovery? 

You should be able to leave the hospital shortly after the operation and resume full normal physical activities after 4-5 days. We would advise you to wear your scrotal support (jock strap) continuously for 48 hours after your operation to minimize discomfort and protect your scrotum and testes. The stitches used are dissolvable and will not usually need to be removed. However, if the stitches have not separated away after 14 days, we would advise you have them removed either in the treatment in the IVF clinic. Most men will experience some mild discomfort or aching for a couple of days. It is advisable to take simple pain relief such as Aspirin, Paracetamol or Ibuprofen regularly, every six hours, for 48 hours after your operation.

Complications after Surgical Sperm Recovery 

The most common complications are an infection or a hematoma (a collection of blood) within the scrotum. Both of these may cause pain, usually within 2-4 days after the procedure. The infection causes increasing tenderness and cloudy discharge around the stitches in the scrotum. A hematoma will usually cause swelling and deep purple discoloration but the risk of this is minimized by you wearing your scrotal support for 48 hours after your operation. If you suspect either of these problems is developing, you should contact the IVF clinic. Out of hours, you can contact the Prasad Hospitals: 8801233333.

Can I have a bath?

It is important not to soak the wound for the first 7 days after the operation. We advise you to kneel in a shallow bath for those 7 days, alternatively showering is fine.

Other information

During the seven days after your operation if you go for a long walk you should wear your scrotal support. Avoid lifting during the first seven days. You should resume a normal diet and increase your daily activities to a normal level over a 3 to 4 days’ period. You should abstain from sports activities, heavy lifting and sexual intercourse for approximately 10 days.

What is Endometrial Scratch? 

The patients who had failed cycles despite transferring good quality embryos, Endometrial scratch is the best procedure to help those embryos to implant successfully after the process of IVF, ICSI. Currently, the evidence suggests that superficially injuring (scratching) the lining of the womb in this group of patients may improve the chances of pregnancy.

Who is the procedure for? 

This procedure is for the women who have the problem of not getting pregnancy even after the transfer of quality embryos. Currently, available evidence does not support the use of endometrial scratch in all patients, including patients going through IVF/ICSI treatment for the first time.  More research is required to evaluate the role of endometrial scratch in patients going through their first cycle of IVF treatment.

How does scratching help implantation?

New research and evidence suggests that scratching the uterine lining causes a ‘repair reaction’ in patients with recurrent implantation failure and this may increase embryo implantation rates:

  • The repair process releases growth factors, hormones, and chemicals. The new lining which grows after the procedure is thought to be more receptive to an implanting embryo and so increases the chances of pregnancy.
  • ‘Gene switching’ - scientists believe that the genes which are responsible for implantation of embryos are sometimes not ‘switched on’ during the time when embryos are supposed to implant. This procedure may switch on the genes which are responsible for implantation and increasing the chances of pregnancy.

Research is still being gathered to understand exactly how this works.

When is the best time to have the procedure? 

The best time to perform the endometrial scratch is during the second half of the cycle before your IVF/ICSI treatment cycle begins.  The clinical team will advise on the best time for the procedure based on your periods.

What preparations are needed for endometrial scratch? 

It is vital that you do not have unprotected intercourse in the four weeks before the planned endometrial scratch procedure. You should use a condom for contraception during the cycle of the scratch appointment to avoid the risk of a possible pregnancy.

  • We recommend taking some pain relieving medication ½ hour before your procedure, such as two paracetamol tablets (500 mg per tablet) as this may help to relieve any discomfort during the procedure.
  • Before the procedure food can be taken. You do not need to empty your bladder before the procedure unless you feel uncomfortable with a full bladder.
  • You should wear comfortable clothing that gives easy access to the lower part of your body.
  • You should bring a sanitary towel with you for use after the procedure.

What happens during my appointment and how is the procedure performed? 

The procedure should only take 15-20 minutes. You may experience a little discomfort but no anaesthetic is required. The procedure is similar to an embryo transfer or cervical smear test.

  • The procedure will be explained to you by the doctor or nurse performing the procedure.
  • Your recent Chlamydia screening results will be checked in the notes.
  • You will be asked to sign a consent form or a verbal consent may be taken prior to the procedure. Following that you will be made comfortable on the examination couch.
  • The cervix can be seen once a speculum is inserted into the vagina gently. Sterile gauze is used to clean the cervix.
  • A flexible catheter is passed into the cavity of the uterus through the opening of the cervix and scratches the lining of the uterus.
  • The catheter is taken out at the end of the procedure.

What happens after the procedure? 

Some mild bleeding is common after the procedure. An hour or two after the procedure you will be able to continue your normal daily activities, but you may benefit from not going back to work the same day. You can eat and drink normally immediately after.

What risks are involved? 

Endometrial scratch is a very safe procedure. For most women it does not require any anaesthetic. Some women occasionally experience some cramping pains during and after the procedure, but these will ease in a very short time. We recommend that you make arrangements for a relative or a friend to drive you home in case you experience more discomfort than usual during the procedure. We will ensure that you are well enough before you leave the clinic.

Very rarely, the procedure can cause pelvic infection. There may be an infection within the cervix that may be spread to the uterine cavity during the procedure. This would become apparent up to 10 days following the procedure. If you suspect and experience any of the following signs and symptoms within a few days of the procedure, please contact your GP and inform them that you have had an endometrial scratch (biopsy):

  • Foul-smelling vaginal discharge.
  • Persistent bleeding.
  • Increasing lower abdominal pain.
  • Unexplained fever.
  • Feeling generally unwell.

Please note that it is recommended to screen all women for Chlamydia prior to endometrial scratch and you already would have been screened with the initial investigations at our department before starting your IVF treatment.

Your doctor or fertility specialist nurse will check this if you have already had a test for Chlamydia within the last 2 years.

What is fallopian tube cannulation (by keyhole surgery)? 

If a woman is suffering from subfertility issues with a blockage in the part of the fallopian tubes closest to the womb, they can have treatment of Fallopian tube cannulation.

Why is fallopian tube cannulation performed? 

About 1 in 6 couples, subfertility problem is seen. There may be many reasons but in 20% of couples, subfertility is because of blockage of fallopian tubes either completely or partially. Normal fallopian tube function is important in allowing the egg (oocyte) to meet the sperm for fertilization (joining of the egg and sperm) and to allow the fertilized egg (embryo) to travel to the womb (uterus). The blockage of fallopian tubes is mostly due to previous infections, adhesions, and endometriosis. These can be diagnosed by hysterosalpingogram (X-Ray Test) or by going laparoscopy.  In a specific group of women, the blockage is in the first and closest part to the uterus (proximal part) and this may be treated by fallopian tube cannulation.

Am I suitable for fallopian tube cannulation?

Fallopian tube cannulation procedure is suitable for: 1. Having subfertility due to tubal factor. 2. When a tubal blockage is diagnosed by a hysterosalpingogram or dye test. 3. If the blockage is at the proximal part of the fallopian tube.

What are the alternatives to fallopian tube cannulation?

Your doctor will be able to advise you regarding the alternatives to increase your chances of achieving a pregnancy-specific to your circumstances. However, in general for couples with subfertility due to the tube factor, the main alternative involves undergoing IVF (in vitro fertilization).

How is fallopian tube cannulation performed? 

This procedure is performed by keyhole surgery with cameras of hysteroscopy and laparoscopy. Hysteroscopy and laparoscopy are surgical procedures that allow the surgeon to access the inside of the womb and the abdomen respectively using a narrow tube that contains a camera and a light source. While visualizing the abdomen and the pelvis through the laparoscope, a fine guidewire is introduced into the womb and the opening of the fallopian tube. It is carefully used to unblock the tube. A dye is then introduced through the womb into the fallopian tubes to check whether it can pass through into the pelvis and determine whether the procedure has been successful. This is similar to the way an artery is unblocked in the heart to treat heart disease.

How successful is fallopian tube cannulation? 

The published evidence suggests that fallopian tube cannulation achieves tubal patency (successfully treating the blockage) in approximately 70% of women and is successful in achieving a pregnancy in 10-20% of women afterward. (NICE interventional procedures Programme 2013).

How safe is fallopian tube cannulation? 

Generally, this is a safe procedure. Serious complications as a result of surgery are rare and occur in an estimated 1 in 1000 cases. These complications are related to the laparoscopy and not the procedure of tubal cannulation itself.   Possible complications from a laparoscopy and hysteroscopy include injury to organs, such as bladder and bowel, and injury to a major artery (blood vessel).   Possible complications of the fallopian tube cannulation procedure include perforation of the fallopian tube (injury of the fallopian tube resulting from the guidewire insertion) in 110% of cases, infection and ectopic pregnancy. Ectopic pregnancies are those which implant outside the womb, most commonly in the fallopian tube and can be dangerous if undiagnosed. However, any woman with complete or partial blockage of her tubes is at a higher risk of developing an ectopic pregnancy. If you successfully conceive after this procedure an ultrasound scan must be arranged at approximately 6-7 weeks’ gestation to ensure that your pregnancy is developing normally.

How long will I need to be in hospital?

Most women will be able to return home on the day of the operation (‘day-case surgery’), although different people recover from a general anesthetic and the operation differently and so you may need to stay in hospital a little longer.

Will I have pain or vaginal bleeding after my operation?

Women who undergo laparoscopy commonly describe lower abdominal, upper leg, and shoulder tip pain. You will also have 2-4 incision sites where the laparoscopy and instruments were inserted over your abdomen. After the operation and for 10 – 14 days the pain may be seen. The team will provide the appropriate pain relief accordingly. Use only sanitary towels whereas tampons increase the risk of developing the infection. If you feel your bleeding is prolonged or becomes foul-smelling, please seek advice IVF specialists.

When can I have sex again?

Yes, you can have but not when vaginal bleeding stopped.  We would recommend trying for pregnancy when you are comfortable sooner rather than later.  Please ensure you have had appropriate investigations regarding ovulation and semen analysis.

When can I return to my normal activities? 

You can resume your normal activities whenever you feel well, like not getting tired. Avoid heavy lifting, housework for 10-14 days.

Can I help towards understanding tubal blockage and its treatment? 

Yes – We are very interested in the outcomes of women who undergo fallopian tube cannulation and whether they have any success in achieving a pregnancy in the future.   Many women are referred from outside our local area and we often do not find out their outcomes. As we are keen to regularly evaluate our services and assess your outcome, we would be grateful if you would agree to be contacted in the future. We would also be grateful if you would contact us with the details below if you successfully become pregnant in the future.

The Baby Movement is a sign that they are fine?

Mostly between 16 and 24 weeks of pregnancy, women can feel their baby move. The type of movements like kick, flutter, and roll, may change as pregnancy progresses.

How often can a baby move?

Every baby has a pattern of movements as there is no set number of normal movements. From 4-6 months, pregnant women can feel the baby movements more and stay up to 8 months and then stay roughly until giving birth.

You must NOT WAIT until the next day to get advice if you are worried about your baby’s movements

  • If the baby’s movements slowed or stopped, contact the team immediately.
  • Don’t neglect your time if the baby’s movements stopped.

Why the baby’s movements are important? 

If the baby’s movements get slowed or stopped, it implicates that the baby is not well. Around 50% of women notice the baby’s movements. Don’t use Doppler or phone apps to check the baby’s heartbeat.

What if the baby’s movements are reduced again? 

If the baby’s movements are slowed down even after the checkup, don’t hesitate to take the advice from the team.

Welcome to the Fertility Preservation Service at Prasad Hospital. 

Overview

Even the cancer treatments are improved, the complications faced by survivors of cancer are more. Many survivors are young and are diagnosed and treated before they have children. Cancer and its treatment can significantly affect the chance of a patient having a child in the future. It is important to the doctors to discuss the effects of fertility after the cancer treatment, they have to give advice or explore whether they store eggs, sperm or embryos before cancer treatment. This helps the patient to have their biological child in the future. If the patient faces cancer and infertility problems, they have to consult the counselors to avoid distress.

The Effects of Cancer Treatment on Fertility

Following cancer treatment, most patients will be advised to delay conceiving for some time.  Female fertility declines sharply in a woman’s mid to late thirties and even just this delay can significantly reduce the chance of conception.

Chemotherapy 

Oocytes (eggs) are highly susceptible to the effects of chemotherapy.  Women treated with chemotherapy are therefore at risk of damage to their eggs, which may ultimately fail the ovaries.  The risk of ovarian failure is higher with increased dose and duration of chemotherapy and with particular types of chemotherapeutic medication. A woman’s period may stop during chemotherapy but may come back up to nine months after chemotherapy treatment has finished.  Although some women will retain eggs in their ovaries after chemotherapy treatment, unfortunately, many will suffer premature ovarian failure and would need to consider treatment with donated eggs if they wish to conceive.

Radiotherapy 

Whilst most chemotherapy treatments are administered systemically (throughout the body), most radiotherapy treatments are directed to a local area.  Therefore, damage from radiotherapy is usually limited to the area treated. Pelvic radiotherapy damages egg highly. Retaining ovarian reserve after the treatment is very rare. Additionally, pelvic radiotherapy can cause damage to the uterus (womb) caused by fibrosis (the formation of excess fibrous connective tissue in an organ or tissue) and a reduction in blood flow.  Following pelvic radiotherapy, it is likely that a woman would need to consider fertility treatment using donated eggs and a surrogate host.

Surgery 

Surgery for gynecological malignancies can impact on a woman’s chance of pregnancy in the future.  It is important that a woman’s decision for future pregnancies is considered and that treatment is performed whenever possible.

Fertility Preservation Options

1. Oocyte Cryopreservation - Egg Freezing 

Women may attempt to ‘freeze’ eggs for future use before they undergo treatment such as chemotherapy, which may affect their egg store.   Oocytes (eggs) are stimulated to develop within the ovaries by daily administration of hormone injections. Following this, the eggs are removed from the ovaries under ultrasound control. The eggs removed are then frozen very rapidly using the technique of Vitrification. Eggs can be stored for up to 55 years. Vitrification is the most effective way of freezing human eggs with more than 90% of vitrified eggs surviving after thawing. Women under the age of 35 years have the chance of 1 in 3 cycles of egg freezing resulting in an ongoing pregnancy. The number of pregnancies depends on the number of eggs stored, with each egg having approximately a 5% chance of leading to pregnancy in women under 35 years. The chance of pregnancy will be more to the younger women. Oocyte Vitrification is still a relatively new technique, however, many babies have now been born after using this technique. Initial data suggest that there is no increase in abnormality rates in babies conceived after eggs frozen in this way.

2. Embryo Cryopreservation (Freezing) 

If a woman is in a stable relationship, the couple may wish to freeze embryos instead of eggs. The woman undergoes a cycle of ovarian stimulation and egg retrieval as in conventional IVF. On the day of egg collection, the male partner is asked to provide a fresh sample of semen, produced on-site in the Andrology Department. All mature eggs retrieved are injected with a single sperm using a technique known as ICSI (Intracytoplasmic Sperm Injection).   On average, about 50-60% fertilize and form embryos. The laboratory will ring you the morning after egg collection to tell you how many eggs fertilized. The embryos are now at the ‘pronuclear’ one-cell stage. It is at this stage that embryos will be vitrified for fertility preservation.  Embryo freezing is a relatively successful procedure and follow-up studies on babies born are reassuring. Embryo storage should only be carried out for couples in a stable relationship as, if the couple separates, the male partner may withdraw his consent for continued storage and treatment. As a result, the embryos would have to perish.

What Treatment Involves 

For both egg and embryo freezing, you will need to undergo ovarian stimulation and egg collection.

1. Ovarian Stimulation 
  • Ovarian stimulation involves daily injections of a drug (Gonadotropin) to stimulate your ovaries.
  • Injections are subcutaneous (beneath the skin) – given through the abdomen or thigh.
  • The site of the injection needs to be changed daily – usually from side to side (left/right). We recommend you do the injections at the same time every day. We will advise on the timing at the start of treatment.
  • The drug dose may change during treatment depending on your response to the drug.
  • You may experience a feeling of heaviness or pressure inside the abdomen as the ovaries get bigger – this is normal.
  • It is important to follow all instructions on drug dosage and timing. You should inform us immediately if there are any problems with this.
  • You will need to administer this injection for approximately 10-12 days.
2. Drugs to ‘switch off’ your hormone production 

In addition to your stimulating injection you will be prescribed GnRH before Antagonist (cetrotide) in the form of injections. You will be advised how and when to administer these injections. You may be asked to continue the antagonist for a week following your egg collection. From 4 to 7 days after egg collection, women with hormone-sensitive breast cancer should take letrozole tablets. The treatment you are prescribed will be individual to you. The protocol and time to start stimulation will be decided depending on any other treatment you are undergoing and to minimize any delay to oncology treatment.

3. Monitoring through stimulation 
  • During stimulation, you will be monitored using blood tests and scans.
  • 2-3 scans are usually done during the treatment cycle to monitor response to treatment – by way of the growth of follicles in the ovaries.
  • All scans during the treatment cycle are performed vaginally, as very detailed scans can be obtained in this way, giving accurate measurements of the ovaries indicates the stage of growth of the follicles and readiness for egg collection.
4. Ovulation trigger with Buserelin 

Buserelin is the last and final injection before egg collection is carried out. The timing of this injection is very crucial.  The injection must be taken at the time advised by the Unit (this is 34-36 hours before egg collection).  This is a late-night injection. This is the last injection you have before the egg collection.

5. Egg collection 
  • Egg collection usually lasts 20-30 minutes and is usually performed in the morning under intravenous sedation.
  • The procedure is guided by a vaginal ultrasound.
  • You will be required to starve from midnight before egg collection (no food, water or chewing gum).
  • Not all follicles seen on scan yield eggs.
  • You may experience some pain and bleeding after the procedure.
  • Chemotherapy, when indicated, could be arranged to commence from as soon as the day after egg collection.

What are the Risks of Fertility Preservation Treatment? 

Throughout treatment, Prasad Hospitals work closely with the team planning cancer treatment, to minimize any risk to you or delay your cancer treatment.

Delay to cancer treatment 

When the intention is to freeze eggs or embryos, ovarian stimulation can start at any time in the menstrual cycle as there is no need to ensure that the lining of the womb is at the same stage of the cycle as the ovaries. However, ovarian stimulation takes a minimum of just over two weeks. It is therefore crucial that women are referred to as early as possible in their treatment pathway to allow them to consider fertility treatment if they wish without delay to their oncology treatment. Women who have acute leukemia and delay for the treatment, are not able to freeze eggs or embryos.

Risk of high oestrogen levels during stimulation 

High levels of oestrogen are seen during ovarian stimulation cycles. This could pose a risk to women diagnosed with oestrogen sensitive breast cancer.  The addition of the drug Letrozole is known to significantly lower oestrogen levels and we use this routinely for oestrogen positive breast cancer patients.  There are no large, long-term follow-up studies, but early data has not demonstrated an increased risk of recurrence or disease progression in these patients.

Risk from egg retrieval 

There is a potential risk for women with ovarian malignancies following egg collection when there could be a spill of malignant cells from the ovary into the abdomen, although in practice this is rarely thought to be significant.  We always discuss this with the oncologist to minimize any risk.

Ovarian Hyperstimulation Syndrome (OHSS) 

About in 1% of women undergoing a cycle of ovarian stimulation for egg recovery, Ovarian Hyperstimulation Syndrome (OHSS) is seen. The risk is no higher in patients undergoing fertility preservation, but we usually continue with drug therapy for one week after egg collection to try to reduce the risk further, so that the woman is in the best position to commence her oncology treatment.

Your Options Once you have considered all the information you may choose:
  • Not to proceed with fertility preservation.
  • To consider possible egg donation in the future.
  • To proceed with egg or embryo freezing.

If you choose to proceed with egg or embryo freezing you will initially be asked to consent for 10 years of storage. Once your oncology treatment is complete you will have the opportunity to discuss your future options. You will be assessed and treated in line with the Clinical Commissioning Group (GGC)/Trust Infertility/assisted conception guidelines.

Counselling 

Patients have found counseling extremely helpful and it is available to all patients referred to us. To make an appointment please ring our reception desk on +9188012333333, or visit: www.prasadhospitals.in

1. Record chart

Blood tests are usually taken between 7.45 and 8.30 in the morning to ensure that we get the results back the same day. Blood is taken to check your oestrogen level. This indicates as to how your ovaries are responding to the stimulation drug.   Scans are usually internal and assess how your follicles are growing. You will be allocated individual appointment times for your scans.   Once you start your stimulation drug please do not stop this unless advised to do so by a nurse or doctor. It takes approximately 10-14 days of stimulation until you are ready for your final (trigger) injection.

2. Trigger injection 

You are now ready to take your Pregnyl injection. Please write down all of the instructions given to you by the nurse on the telephone.

Please note: Your egg collection is timed to be 34-36 hours after your Pregnyl or Buserelin injection.

3. Day of egg collection 

Please bring:
  •  Dressing gown.
  •  Slippers.
  •  Sanitary towels.
  •  Something to read.
Don’t forget!
  • Nothing to eat or drink from midnight the night before your egg collection.
  • If you are storing embryos your partner is to abstain from ejaculation for 2-4 days before the day of egg collection.
Post egg collection

Following your egg collection, you may feel bloated, have mild abdominal pain and light vaginal bleeding on some days. The lab staff will telephone you the day after your egg collection to inform you of the number of eggs/embryos stored.

4. Menopur 

What does it do?

Menopur with the aim of an egg developing within each follicle stimulates in ovaries.

Possible side effects: 
  • Local irritation at the injection site.
  • Ovarian Hyperstimulation Syndrome (OHSS).
Signs/symptoms to look out for include: 
  • Abdominal swelling/pain.
  • Shortness of breath.
  • Extreme thirst.
  • Nausea/vomiting.
  • Headaches.
  • Problems passing urine (small amounts or none at all).
  • Local irritation at the injection site.
How to prepare Menopur: 
  1. Remove the product from the box.
  2. Open the top tray, which will contain pre-filled syringes of water, a vial of powder and a needle.
  3. Remove the powder vial from the tray.
  4. Flick the blue cap off.
  5. Remove the grey lid off the pre-filled syringe of water and twist the orange needle on to the top.
  6. Push the needle through the grey bung on the powder vial.
  7. Push all the water into the vial of powder. If you have two pre-filled syringes of water, remove the needle from the first syringe and attach it to the second and inject it into the vial of powder.
  8. The powder should all dissolve. If not completely dissolved, give the vial a gentle roll. Do not shake.
How to inject Menopur: 
  1. Take a needle from the large box.
  2. Remove the clear lid.
  3. Pierce the grey bung and tip the vial upside down.
  4. Pull down the plunger to just past your required dose.
  5. With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
  6. Pull the plunger down and push out the air, ensuring the top of the black plunger lines up with your required dose.
  7. Pinch an inch of skin below your belly button.
  8. Inject at a 45-degree angle.
  9. Inject the full dose.
  10. Remove the needle.
  11. Dispose in sharps bin provided.
  12. The remaining solution of Menopur can be stored for the next dose.
Storage Information

Store in a refrigerator (2°C - 8°C) before reconstitution, in its original container to protect from light. The solution may be stored for a maximum of 28 days at not more than 25°C after the reconstitution and also don't freeze.

5. Bemfola 

What does it do? 

With the aim of an egg developing within each follicle, Bemfola stimulates the follicles in your ovaries.

Possible side effects:
  • Local irritation at the injection site.
  • Ovarian Hyperstimulation Syndrome (OHSS).
Signs/symptoms to look out for include:
  • Abdominal swelling/pain.
  • Shortness of breath.
  • Extreme thirst.
  • Nausea/vomiting.
  • Headaches.
  • Problems passing urine (small amounts or none at all).
How to use Bemfola:
  1. Take the syringe and needle out of the box.
  2. Remove the peel tab from the injection needle after washing your hands.
  3. Gently push after aligning the injection needle with the pen.
  4. Remove the outer needle protection cap.
  5. Remove the inner needle protection cap.
  6. Hold the pen with the needle pointing upright to make eventual air bubbles rise.
  7. Push the dosage plunger until it stops and a small amount of fluid is seen. If a small amount of fluid is not seen the pen should not be used.
  8. Turn the dosage plunger until the prescribed dose is aligned with the middle of the indent.
  9. Pinch an inch of fat below your belly button.
  10. Inject Bemfola at a 90-degree angle.
  11. Push the plunger until it stops.
  12. Remove the injection needle after 5 Sec.
  13. Dispose of the needle into the sharps bin provided.
Storage

Store Bemfola in the refrigerator and in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum of 28 days.

6. Gonal F

What does it do?

Gonal F is an injection that contains the follicle-stimulating hormone (FSH). It stimulates your ovaries to produce follicles, aiming to produce an egg inside each one.

Possible side effects:
  • Local irritation at the injection site.
  • Ovarian Hyperstimulation Syndrome (OHSS).
Signs/symptoms to look out for include:
  • Abdominal swelling/pain.
  • Shortness of breath.
  • Extreme thirst.
  • Nausea/vomiting.
  • Headache.
  • Problems passing urine (small amounts or none at all).
  • Local irritation at the injection site.
How to use Gonal F:
  1. Take out the Gonal F pen and one of the needles inside your box.
  2. Take the white lid off the Gonal F pen.
  3. Peel the paper cap off the needle.
  4. Twist the needle on the top of the Gonal F pen.
  5. Remove white cap off the needle.
  6. Look in the black window at the end of the pen (there should be a ‘0’).
  7. Twist the red end of the pen till you can see your required dose in the black box.
  8. Remove the green lid on the needle.
  9. Pinch an inch of fat below your belly button.
  10. Inject Gonal F at a 90-degree angle.
  11. Push the red plunger down and hold for 10 seconds.
  12. Remove pen and look in the black window (it should read ‘0’ if you have injected the full dose).
  13. Replace the white cap on the needle and unscrew it off the pen.
  14. Dispose of the needle into the sharps bin provided.
  15. Replace the lid of the Gonal F pen and store as advised below.
Storage Information

Store Gonal F in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum of 28 days.

7. Cetrotide

What does it do?

The natural hormone which is called Gonadotropin-Releasing Hormone (GnRH) is effected by the blockage by cetrotide. GnRH controls the secretion of another hormone called luteinizing hormone (LH) which induces ovulation during the menstrual cycle.

Possible side effects:
  • Mood swings.
  • Hot flushes.
  • Headaches/nausea.
  • Vaginal dryness.
  • Local irritation at the injection site.
How to use Cetrotide:
  1. Remove from packaging.
  2. Remove blue cap from vial of powder.
  3. Take a pre-filled syringe of water and remove the cap.
  4. Attach the yellow needle (larger needle) on the end of the pre-filled syringe of water.
  5. Pierce the grey bung with the needle and push all of the water into the vial.
  6. Draw up all the solution back into the syringe once the powder has been completely dissolved.
  7. Remove the large yellow needle and dispose in sharp bin provided.
  8. Attach on a grey smaller needle.
  9. With the needle pointing towards the ceiling, flick the syringe so that any air bubbles move to the top.
  10. Push the plunger up so no air is in the syringe.
  11. Pinch an inch of fat below your belly button.
  12. Inject at 45-degree angle.
  13. Push the plunger down to administer Cetrotide.
  14. Dispose of needle and syringe into a sharps bin.
Storage information:

Keep in the box in a dry cool place.

8. Pregnyl

What does it do?

Pregnyl is your final injection and is used to mature the egg within the follicle.

Possible side effects:
  • Headache.
  • Feeling restless or irritable.
  • Depression.
  • Breast tenderness or swelling.
  • Local irritation at the injection site.
How to use Pregnyl:
  1. Remove the two glass vials from the box.
  2. The black dot on the bottle is the weakest point of the vial, flick this dot to make the neck of the vial weak.
  3. Put your left thumb underneath the black dot and your right thumb above the black dot.
  4. Firmly snap the top of the vial.
  5. Repeat with the other vial.
  6. Remove syringe and green needle from the packaging.
  7. Twist green needle at the end of the syringe.
  8. Put the needle into the water and pull the plunger to draw up all the water.
  9. Remove the needle from the bottle and put the needle into the vial of powder.
  10. Push all the water into the vial.
  11. Leave to dissolve for a few seconds then pull the plunger back to draw up a dissolved drug.
  12. With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
  13. Twist off the green needle and dispose in sharps bin provided.
  14. Twist on an orange needle and push the plunger up to remove any air.
  15. Pinch an inch of fat below your belly button.
  16. Inject at 45 degrees and push the plunger down to give yourself a full injection.
  17. Remove the needle and dispose into the sharp bin.
Storage Information

Store in a refrigerator until it is time to administer the injection.

9. Buserelin  

What does it do?

Buserelin is a drug that causes ovarian suppression.  It stops the production of natural hormones that control the release of eggs from the ovaries by acting on the pituitary gland in the brain.

Possible side effects:
  • Mood swings.
  • Hot flushes.
  • Vaginal dryness.
  • Headaches.
  • Nausea.
  • Local irritation at the injection site.
How to use Buserelin:
  1. Remove Buserelin vial from the box.
  2. Flick the blue cap of the lid (this does not need to be replaced afterward).
  3. Take out a needle from the pack you were given.
  4. Remove the orange cap from needle.
  5. Pierce grey bung of Buserelin with the needle.
  6. Tip the vial upside down.
  7. Pull down the plunger to just past your required dose.
  8. Remove the needle from the vial.
  9. With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
  10. Pull the plunger down and push out the air, ensuring the top of the black plunger lines up with your required dose.
  11. Pinch an inch of fat below your belly button.
  12. The needle is to be injected at a 45-degree angle.
  13. Push the plunger to give yourself the whole injection.
  14. Remove the needle and dispose of it in the sharps bin that you have been provided with.
  15. Put the remaining Buserelin in the refrigerator.
Storage Information

If Buserelin is once opened, it should be stored in a refrigerator.

10. Cabergoline 

Ovarian hyperstimulation syndrome is resulted by administering human chorionic gonadotrophin (hCG) in ART (Assisted Reproduction Technology). Severe OHSS appears in about 3-8% of IVF cycles. Recently, cabergoline has been introduced to help prevent OHSS in women at high risk of OHSS who are undergoing ART treatment.

How to use cabergoline Cabergoline is a tablet. Please take it as instructed.

11. Metformin 

What does it do?

Metformin is prescribed during IVF treatment for some people with Polycystic Ovary Syndrome (PCOS) or those with a high ovarian reserve. The use of Metformin can help to reduce the risk of Ovarian Hyperstimulation Syndrome (OHSS).

Possible side effects:
  • Diarrhoea.
  • Nausea/vomiting.
  • Abdominal pain.
  • Loss of appetite.
Storage information Keep Metformin in the packaging in a cool, dry place.

What is flu? What are the symptoms?

Flu, which can be sometimes called Seasonal flu, causes usually in the winter season. It’s an infectious disease. The common symptoms are cold with a stuffy or runny nose, sore throat, fever, headache, chills, extreme tiredness, and pains in the joints and muscles. Mostly, the infected one can recover on 2 to 7 days, but for some, it may lead to hospitalization and sometimes even death.

What causes flu?

Flu infects the windpipe and lungs and it is caused by influenza viruses. And because it’s caused by viruses and not bacteria, antibiotics won’t treat it. Even there are some complications caused by flu, sometimes antibiotics may be needed.

How to catch flu and avoid it?

When a person is infected with flu and coughs or sneezes, the saliva can be spread over a wide area. When the other persons breathed in or touched the surface area where the droplets are landed, they might be infected. The virus spreading can be avoided by covering the mouth and nose while coughing or sneezing, washing hands properly. The best way to avoid spreading flu is by having a vaccination.

How can we protect against the flu?

To protect against flu, vaccination is the best way. The most likely viruses that will cause flu are identified in advance of the flu season and vaccines are then made to match them as closely as possible. However, there is always a risk of a change in the virus.  From the last ten years, the vaccine has generally been a good match for the protection from spreading.

What harm can the flu do?

Not all persons suffering from cold, have affected by the flu. Flu is much worse than cold. The person who suffers from flu needs to stay in bed for some days. Some may have the risk of developing serious illnesses like pneumonia and bronchitis or even existing conditions worse. In the worst cases, it may result in death. Flu vaccines help to protect against the virus.

How to Know if a person is at increased risk from the effects of flu?

Flu can affect anyone, but even a person feels that the condition be well managed, it might worsen the health condition. The person has to get a free flu vaccine if the person is pregnant or having long term conditions like:

  • Heart Problem.
  • Bronchitis or Asthma.
  • Kidney Diseases.
  • Low immunity.
  • Liver Disease.
  • Transient Ischemic Attack (TIA).
  • Diabetes.
  • Sickle-cell Disease.
  • Overweight (BMI > 40)

By having the vaccination, there can be chances of reducing the spread of flu to other people.

Who should consider having a flu vaccination?

The vaccination can be done for all those who have the above conditions or

  • The persons who are aged 65 or above.
  • Disabled person.
  • Living in a residential or nursing home.
  • Pregnant woman.
  • Social care worker.
  • Children of a certain age.

I had the flu vaccination last year. Do I need another one this year?

The vaccination should be done every winter to have protection against the strains of flu. Because the conditions may be different when compared with the previous year. The flu vaccine may last about 6 months only.

Can the person who has flu, need a vaccination?

Yes; the person who has flu can take a vaccination as it helps not to spread to others.

What about the children? Do they need vaccination?

The child with above 6 months’ age having the conditions mentioned above, should have a vaccination. The flu vaccination won’t work well for the babies under 6 months’ age. That’s why the pregnant woman should have vaccination compulsorily which helps in passing some immunity to their baby and protect them from flu.

Do pregnant ladies have to take a flu vaccination? 

Of course Yes, all pregnant women must have the flu vaccination to protect themselves and even their babies. The vaccination can be given at any stage of pregnancy. Pregnant woman having the flu vaccine can have benefits like

  • Reducing the risk complications like pneumonia, mainly in the later stages of pregnancy.
  • Reduce the complications like the baby born soon or with low weight.
  • For the first six months of a born baby may have immunity.
Reduce the chance of pregnant women passes flu to her baby.

What to do if a pregnant woman has flu? 

If a pregnant woman has the symptoms of flu, immediately approach the doctors' team. She can also get flu-free vaccination. Some groups of children are given vaccination to prevent the spread of flu to their parents or friends or any neighbours.

Can the flu vaccine be given to my child at the same time as other vaccines?

The flu vaccine can be given at the same time as all other vaccines. The vaccination can be given if the child has some minor illness.

Is there anyone who is not needed to have the vaccination?

Everyone can have the vaccination, but the person should not have the vaccination if he/she has conditions like having serious allergy due to vaccines, allergic to eggs, having low immunity, having a fever.

What about the children? 

Children should not have the vaccination if they have conditions like
  • Have wheezy since past 3 days.
  • Are severely asthmatic.
  • Have a condition like low immunity.
  • Allergic to eggs.

Does the nasal vaccine contain gelatin derived from pigs (porcine gelatin)?

Yes. The nasal vaccine contains a highly processed form of gelatin (porcine gelatin), which is used in a range of many essential medicines. The gelatin helps to keep the vaccine viruses stable which makes the vaccine provide the best protection against flu.

Can’t the child have the injected vaccine that doesn’t contain gelatin?

The nasal vaccine provides the best protection from flu, mainly in young children. It also helps to reduce the risk to their parents or baby brother or sister. But the injected vaccine cannot offer all these. Who have a high risk of flu and can’t have the nasal flu vaccine, they can have the flu vaccine by injection.

How long will the person be protected?

The vaccine protects for about 6 months.

Will the flu vaccine protect the person completely?

Flu is caused generally in winters. The vaccination lasts for 6 months only. And the flu virus risks may be different or change from year to year.

Will there be any side effects?

Some of the side effects of the nasal vaccine are
  • Runny or blocked nose.
  • Tiredness.
  • Loss of appetite.
  • Headache.
Injected vaccinations can have side effects like
  • Low-grade fever.
  • Muscles aching for one or two days.

Summary of who are recommended to have the flu vaccine 

The vaccination is recommended to the people.
  • Aging 65 or above.
  • Pregnant woman.
  • Children of ages 2 and 3.
  • Children studying primary classes (Up to 5th Class).
  • Who takes care of disabled or old age people.
  • Social care workers

Before starting fertility treatment, one should need to complete several consent forms. This is to allow us to be sure that you understand the treatment being planned and all its implications. We appreciate that it may sometimes seem like there is a lot of paperwork to go through, but the purpose of this will make us deliver a safe and good service complying with the law governing fertility treatment. This document describes the different consent forms and the issues to think about when completing them. Besides, our staff is always happy to answer any questions you may have about the consent forms and we will also discuss them at our face-to-face consultations with you. We also have a dedicated counseling service, which we encourage you to use, particularly if you are having a treatment that involves using donated sperm, eggs or embryos. Please remember that you have the right to withdraw or change your consent for this treatment at any time. There is no need to give us a reason. You must let us know in writing if you want to withdraw or change your consent and we will ask you to complete an updated set of forms. Please make an appointment to see one of our teams to do so. You must not consent to this treatment unless you have had all the information you need to understand the implications of this treatment. If you feel you need more information, please ask us. We are here to help you understand your treatment choices and to remain in control of your treatment.

1. Consent for treatment 

This form is just similar to the forms which you fill before any medical treatment. It asks you to consent to any procedures required, such as egg collection and embryo transfer. Before completing this, you should have an understanding of the procedure involved, whether it is to be carried out under sedation or anesthetic and the potential risks.

2. Consent to disclosure of information (CD Forms)

Each partner undergoing treatment is required to complete a CD form.

Your absolute confidentiality is protected by law. We are not allowed to tell your general practitioner or anyone else about your treatment (other than in a medical emergency) unless you have specifically allowed us to do so. While looking for continuous care like in pregnancy, it is recommended that to inform your General Practitioner (GP) about the consent. So, once the GP receives information about fertility treatment, they maintain safety and improve the quality of care with maintaining confidentiality. We also recommend that you allow access to your information to administrative and audit staff that support our clinic. This is both to ensure the smooth working of the service and also to ensure that its processes and results can be monitored and improved for the benefit of patients. We are legally obliged to collect certain information about you and your treatment and pass it to the Human Fertilization and Embryology Authority (HFEA). This includes personal data such as your name and address, the type of treatment you had, the number of embryos transferred and whether your treatment led to pregnancy. Information about a child after the treatment is also collected. If you give consent, the HFEA can release some of this identifying information to researchers, for research projects that meet strict guidelines. You can choose not to allow this. However, we believe that this kind of research is potentially very valuable in assessing the effectiveness and safety of fertility treatment, to develop new techniques and to study the effect of national policies. You can choose to give consent to your identifying information being used for certain types of research only. If you choose to consent for non-contact research only, you will never be contacted about research using your identifying information. This information will only be used to link the HFEA database with other databases. If you consent to contact research, staff may contact you in the future if they think you may be suitable for a research study. Giving consent to be contacted does not mean that you are automatically consenting for any future research study.

3. Consent to the use and storage of sperm, eggs and/or any embryos produced from them

(WT form for women, and MT form for men)

You can consent to the use of your gametes (eggs and sperm) and embryos for your treatment, the treatment of others, research or training (or all of these). You can also give consent to the storage of these, which means freezing them for future use. Before giving this consent you should be happy that you understand the nature, purpose, and implications of the treatment being proposed. We will provide information about this to you at our face-to-face consultations and through written materials. We place a high priority on our patients being fully informed and staff will always be happy to provide clarifications and more information if you feel you require this. Please remember that you can specify extra conditions for storing or using your eggs, sperm, and embryos. When considering consent for the storage of gametes and embryos, it is important to know that the statutory storage period is up to 10 years and can be specified in the consent form. In certain cases, storage can be extended beyond 10 years if you consent to this and a medical practitioner certifies that either you or the person to whom your gametes or embryos have been allocated has, or is likely to develop premature infertility. In these cases, the opinion of the medical practitioner has to be renewed every 10 years, and the maximum period for which gametes and embryos can be stored is 55 years. The law does not allow us to keep your gametes or embryos in storage beyond the date you have consented to. Before the end of the storage period, our team will get in touch with you. It is important that you keep in touch with us, in particular, that you notify us of any change of address.  We are obliged by law to not let any stored eggs, sperm or embryos to perish. The consent forms MT and WT ask you whether you agree to be approached to participate in research studies involving your sperm, eggs or embryos. Agreeing to this does not commit you to participate in any particular research, rather it allows us to provide you more information which you can use to decide whether to participate or not. Research studies are all approved by Ethics Committees and are designed to help us understand infertility better and to improve the treatment of couples such as yourselves. However, we are aware that not everyone feels comfortable participating in research. Please be reassured that your treatment will not be affected whether you consent for research or not. The consent form also asks you to think about what you would like to happen to your gametes and embryos if you were to die or become permanently incapacitated. We appreciate that considering some of these scenarios may be distressing, but it is important that you have given some thought to this. We find that this is quite a useful prompt for an important conversation between partners, as it asks you to think about uncommon but very distressing scenarios and helps you fully prepare for your treatment. Our staff and specialist counselors are there to help you talk through any issues that may arise or to provide any clarification you may need.

4. Consent to parenthood

Before the treatment starts, the relevant consent forms are to be filled if the one is having the treatment with donor sperm, donor eggs or embryos. This is to ensure that any child born has a legally recognized father or second parent. There is a difference in law between the legal status of a ‘father’ or ‘second parent’ and a person who has parental responsibility for the child. The law specifies who can be a parent in various circumstances. We will provide you information about who will be the legal parent(s) under the HFE Act 2008 and other relevant legislation in your circumstances. Our patient information leaflet ‘Legal Parenthood’ lays out how the law applies in different scenarios and helps you understand who is allowed to be the legal parent and how this can be ensured. The HFEA website www.hfea.gov.uk is an excellent source of information about this, and other issues discussed above. In some cases, seeking legal advice may be useful.

5. Withdrawing, varying and restricting consent

You may withdraw your consent at any time up to the point that your eggs, sperm or embryos have been used in treatment, research or training, or been disposed of. To do so, please let us know straight away, in writing. We will ask you to complete the relevant HFEA consent forms designed for this purpose. If one of the partners whose sperm or egg was used to create embryos withdraws their consent to the storage of those embryos, then we will take all reasonable steps to inform the intended recipient of the embryos. The embryos can be stored for up to 12 months after we receive written notification of the withdrawal of consent, provided the 12 months does not extend beyond the statutory storage period. However, if the intended recipient also consents to the destruction of the embryos then we will dispose of them straight away, as required by the HFEA. You can also vary your consent if you change your mind at any time up to the point that your eggs, sperm or embryos have been used in treatment, research or training, or been disposed of. This may occur if, for instance, you were to change your mind about the use of your sperm, eggs or embryos in the event of your death. If this were to be the case, please let us know straight away in writing and we will go through the relevant consent forms with you. You can also restrict your consent about the use or storage of your eggs, sperm or embryos. For instance, you can state that you wish their donation only to treat a known recipient. Restrictions can be stated on your main consent form or a separate paper, signed, dated and attached to the form.

Violence, Aggression and Harassment Control Policy

Prasad Hospitals is committed to well-being and safety to the patients and staff. Physical violence, verbal abuse, and harassment are unacceptable.

Improving health will benefit the people in many ways and benefits too for couples who are trying to have a baby. Healthy lifestyle improves the fertility and may increase the chances of successful treatment.

How can I improve my health and fitness before my treatment? 

This is a commonly asked question so we have put together some advice for both men and women to help you improve your health and fitness.

Stop smoking
  • The most important thing you can do if you smoke is - give up!
  • We know this is easier said than done but many research studies have shown the harmful effects of smoking on sperm quality, egg quality and implantation rates for fertilized eggs.
  • Smoking affects many aspects of your general health such as increased risk of cancer, heart disease, lung disease and premature ageing.
  • Passive smoking can affect partners and other people.
  • Smoking is an expensive way to damage your health!
Achieve a healthy body weight 
  • A healthy weight for height is referred to as a healthy Body Mass Index (BMI).
  • You can check your BMI using the enclosed chart.
  • It is important that you are both as near to your ideal BMI as possible.
  • Being overweight or underweight can cause general health problems but can also affect your fertility.
  • Aim for a BMI of between 21 and 30 (ideally 21 to 25).

If you need help achieving your ideal weight, then contact your GP for a referral to a dietitian. Note: Healthy weight loss is a slow, gradual process. As you wait for your treatment – use this time wisely A loss of 1-2 lb (0.5-1.0 kg) per week is adequate.

Take regular exercise 
  • Regular exercise improves physical fitness, helps you to lose weight and decreases stress levels.
  • Aim for some form of ‘Aerobic exercise’ three times per week, i.e. any activity that increases your heart rate and breathing, such as brisk walking, jogging, swimming, or sporting activities like football, tennis or squash.
  • You do not need to join an expensive club or buy lots of equipment to get enough exercise. A brisk twenty-minute walk two to three times per week can be beneficial.
  • Using stairs instead of using lifts/escalators and walking to the shops can all make a difference and will improve your fitness.
Reduce your alcohol intake 
  • Excessive alcohol reduces fertility and damages sperm.
  • For general health purposes the safe limits are up to 14 units per week for both men and women.
  • It is better to have one to two units occasionally rather than saving them all up for one night!
  • However, men and women trying for a baby should limit alcohol intake to no more than 6 units per week for men and women should avoid alcohol completely.
Drink plenty of water
  • Studies suggest that excessive caffeine can reduce your fertility – tea, coffee, cola and ‘energy’ drinks e.g. Red Bull has high caffeine. Try to reduce caffeine in your diet and also drink more water.
  • When you are having your treatment cycles we will suggest that you avoid caffeine altogether.
Follow a healthy eating plan
  • Eat regular meals.
  • Eat similar foods to the rest of the family.
  • Enjoy your food.
  • Eat a wide variety of different foods.
Why is healthy eating important? 
  • Eating healthy food makes you to achieve and maintain a body weight.
  • It ensures your body has sufficient vitamins and minerals – essential for men and women trying to conceive.
  • It ensures your body has enough energy for all your daily activities.
Eat more fruit and vegetables 
  • Fruit and vegetables are excellent sources of vitamins and minerals. Eat more fruits and vegetables.
  • If you are trying to lose weight fruit makes an excellent snack or dessert.
  • Choose fresh, frozen or tinned.
  • Examples of a portion are:
    • 1 apple, pear, banana.
    • 1 slice of melon or pineapple.
    • 2 plums or satsumas.
    • 1 cup of strawberries/raspberries.
    • 2 tablespoonful of vegetables (raw, cooked, frozen or canned).
    • 1 dessert bowl of salad.
Fill up on starchy foods:
  • This includes bread, cereals and potatoes.
  • Try wholegrain varieties where possible, for example, whole meal bread, bran flakes etc.
  • These are higher in vitamins and minerals and also help to fill you up - so you are less tempted to snack between meals.
Meat, fish and alternatives:
  •  These foods are important for protein and iron as well as other nutrients.
  • Vegetarians should include pulses, beans or nuts to replace meat or fish.
  • Take care with fat content of meat or fish - especially if trying to reduce your weight.
Dairy Products: 
  • Milk, cheese and yoghurt are important for calcium, protein and other nutrients.
  • Choose low fat varieties as much as possible, for example, skimmed milk, cottage cheese or low fat yoghurt (especially if trying to lose weight).
  • Low fat varieties have more calcium.
 Occasional foods:
  • Many snack and convenience foods such as sweets, chocolate, biscuits, burgers, cakes, crisps and pastries contain lots of fat and sugar.
  • They are low in vitamins and minerals and high in calories, so should only be eaten occasionally.
  • Added fats e.g., butter, oils and margarine, should be used sparingly.
Take Folic Acid 
  • It is strongly recommended that women take 400µg of folic acid per day, for 3 months before pregnancy and until 12 weeks after you conceive.
  • Good dietary sources of folic acid include fortified breakfast cereals, fortified bread, sprouts, spinach, Bovril and oranges.

Do I need to take any other supplements? 

Please seek advice from a pharmacist before taking any other vitamin supplements or herbal remedies.

Want to know more?

Ask your GP to refer you to a State Registered Dietitian, or you can contact 8801233333.

Improving sperm quality 

The effect of heat

The normal activity of the sperm producing tubules in the testes is affected by heat. Intermittent overheating of the testes leads to a reduction in sperm production and/or a decrease in sperm activity (motility).  The testes are situated in the scrotum mainly because it is cooler there than inside the body cavity. The testes have their own heat regulating mechanism so that in cold conditions the scrotum contracts, pulling the testes closer to the body, whereas in hot conditions the testes hang much lower. Overheating of the testes can be caused in various ways:

  • Soaking in hot baths.
  • Working in a high environmental temperature.
  • Jacuzzis or saunas.
  • Wearing tight or support underwear.

Illness associated with fever have a tendency of reducing fertility but temporarily. Remember that sperm take 70 days to develop from their cells of origin, thus any episode of testicular overheating could affect your fertility for over two months.

To improve your fertility, you should:
  • Avoid hot baths, Jacuzzis and saunas and change to having showers or lukewarm baths.
  • Wear non-support, non-insulating cotton boxer shorts.

There is some evidence to suggest that in some cases the taking of zinc and vitamin E can improve sperm quality.

Other Factors:

The use of certain medications, including anabolic steroids or recreational drugs such as marijuana can affect your sperm quality. If you are taking any medication, please discuss this with the staff.

Cope with stress 

Our Team knows couples undergoing infertility treatment experiences an extremely stressfulness. However, it is not stress itself that causes problems but the way in which an individual respond to it. Without positive ways of dealing with stress a couple undergoing infertility treatment may experience some very negative symptoms such as:

  • Insomnia.
  • Fatigue – constant lack of energy.
  • Anxiety.
  • Inability to concentrate for long.
  • Mood swings.
  • Depression.

Our staff helps the couples to avoid the stress and its symptoms. For this reason, we recommend that you give some thought now as to the coping mechanisms you currently employ to deal with stress. Some ways to get away with stress are

  • Yoga.
  • Physical exercise – swimming, running etc.
  • Learning how to relax – using tapes, books, videos.
  • Stress management courses.
  • Support – building your own network using friends, family, counsellors.

What is ICSI and Why is it necessary?

Intracytoplasmic sperm injection (ICSI) refers to the technique of injecting a single sperm into the center (cytoplasm) of the egg.  In natural conception, many numbers of sperms surround the egg, but only one sperm penetrates and fertilizes each egg.  In standard IVF we mimic nature by adding number of sperms to the dish containing the egg.  In the technique of ICSI, the sperms are selected based on the activity and appearance. Later, using specialized equipment which allows the egg and sperm to be handled, a single sperm is injected into the mature egg.

Which couples require ICSI?

If there is a sperm problem or having the risk of egg failing to fertilize, ICSI is recommended. If there is no sperm problem, the IVF process is recommended. Sometimes, the sperm sample may be unexpectedly poor on the day of egg collection. If this happens, we will carry out ICSI to try to achieve fertilization. We may also recommend ICSI if you have had standard IVF and there was a very low fertilization rate or no fertilization. This may happen even if there is no sperm problem. If this happens in your case, we will discuss the alternatives and whether ICSI is likely to help.

How is ICSI carried out?

Every aspect like egg recovery, producing a sperm sample, hormonal simulations, and embryo replacement are the same or identical in ICSI and IVF techniques except the method of fertilization. The embryologist sees inside the egg after removing outer cells from each egg to access whether the egg is mature or not. Only matured eggs can be used in ICSI whereas all eggs can be used in IVF. In most treatment cycles, approximately 80% of eggs are mature.  The sperm are prepared as normal for IVF.  The embryologist then picks out individual live sperm, of normal appearance and injects one into each egg, using a special glass needle.

 How successful is ICSI? 

About 60% of eggs will be fertilized by ICSI which is similar to IVF. Reasons for not being 100% successful are

  • The eggs which aren’t matured cannot be injected.
  • Some eggs might be damaged during an injection procedure.
  • Many sperms don’t have the capability of activating the egg when injected directly.

Embryo development is similar for ICSI and IVF on following successful fertilization.

What risks are associated with ICSI treatment? 
ICSI offers the opportunity of success for couples. However, it also additionally carries risks over and above those of IVF treatment in general. It is known that abnormal sperm production, as is the case in men with very low sperm count or absent sperm in the ejaculate, can be associated with genetic defects in the male. There may be a problem of genetic defects directly transmitted to the children by the ICSI technique. There is a possibility of the egg getting damaged by the injecting procedure. Theoretically, this can result in damage to the resulting embryo if the damaged egg is fertilized normally.

What is Induction of Ovulation?

The process of stimulating the ovaries that produce one or two follicles containing an egg each is Induction of Ovulation. The process is used in one of two ways:

  • Natural intercourse: This is the method suitable for couples with ovulatory disorders where the eggs are released at a time coinciding with regular intercourse and creates the opportunity of achieving pregnancy.
  • Stimulated intra-uterine insemination (S-IUI): S – IUI is the method suitable for the couples facing the problems with unexplained infertility, endometriosis, and some mild sperm abnormalities.
What is involved in the treatment?

Visit the specialists on the first day of your period (the day you wake up bleeding) to request treatment. Blood test and Day 2 cycle, Day 3 cycle scans are mandatory. With respect to the results, should take gonadotropins injections daily to simulate the ovaries. On the Day 8 of cycle, blood test and transvaginal scan should be done, where the development of follicles can be monitored. The injections are continued till the matured follicles (measuring around 16 mm or above) are confirmed on the scan. Then, hCG injection should be taken in order to stimulate ovulation.

What are the risks?

The drugs are given in low doses. There may be a risk of OHSS, regular monitoring prevents this complication. If you observe symptoms like vomiting, shortness of breath, nausea or have severe abdominal pain, visit the hospital immediately. If more than 2 follicles are developed, the cycle must be canceled because there might have a risk of multiple pregnancies. If 6 or more follicles development and you are eligible for IVF, rather than cancelling the cycle, you would be offered the chance to convert to IVF.

Sperm storage is provided as back up for your infertility treatment at Prasad Hospitals. A fresh semen sample would be used on the day of your infertility treatment whenever needed.

How are the samples produced and stored?

Semen samples are collected and stored in a small bottles sealed with liquid nitrogen vapour and are labelled with the name, and contact details. Freezing takes place as soon as possible after the sample is given, so it is better if the sample is produced on the premises.

Can my wife/partner accompany me?

Yes. However, it is not essential and you will be seen alone if you prefer.

How do I get the results?

You can confirm by contacting the team if your sample was frozen and has been assessed for suitability as back up for infertility treatment.

How long can sperm be stored?

According to the law, sperm can be stored up to infertility treatment or until 10 years. Samples can be destroyed after the period. So it is important that you keep us updated with any changes in your details so that we can contact you.

What if something goes wrong with storage?

Even we make possible safety arrangements of your samples, we do not guarantee against all the eventualities. For example; in the event of a strike or civil disturbance interrupting the supply of liquid nitrogen, or in the event of equipment failure, the effect on your samples could be detrimental.

What happens if one's sperm not stored?

If the sperm sample fails frozen process or not successful in storing the sperm, you can approach the specialists to know alternative options.

When can we use the sperm?

Once the sperm freezing procedure is complete, the doctors team notifies and update to the person. Within a few weeks you and your partner will be seen in the clinic in order to complete the relevant documentation/consent forms and to discuss the IVF treatment process before starting the treatment.

How are these samples used?

These samples are stored only as a backup for infertility treatment. On the day of infertility treatment, a fresh semen sample is preferable.

How successful are these treatments?

Different methods have different success rates. It also depends on the couples. And also frozen sperms cannot guarantee the pregnancy. All of this will be explained to you when you and your wife/partner are seen by the doctor.

What are the prospects of using frozen sperm?

The quality of sperm samples depends on patients and some circumstances like having weight loss, having loss appetite. Cancers that affect the whole body, such as leukemia, may have a more profound effect when compared to localized tumors with a malignant potential. We will always offer you the chance rather than make judgements ourselves. During the freezing process, to protect against damage, samples are diluted with a preservative. Even, it cannot be guaranteed that the sample survives for the whole freeze-thaw process. As previously stated the chances of success in achieving a pregnancy depend on many factors including the method chosen for their use. Chances of pregnancy can be expected if sufficient number of sperm with quality have been frozen.

Counselling

Infertility counselling sessions are available at Prasad Hospitals and the appointment should be taken for the session.

Violence, Aggression and Harassment Control Policy

We are committed for the safety of patients. Verbal abuse, physical violence, and harassment are not allowed at Prasad Hospitals.

Suggestions, Concerns and Complaints
If you would like to provide feedback you can:
  • Ask to speak to the ward or department manager - they may be able to help straight away.
  • Write to us: Prasad Hospitals, Adj. BSNL Telephone Exchange, Nacharam – Mallapur Road, Secunderabad – 76 (or) e-mail: info@prasadhospitals.in
We welcome your feedback so we can continue to improve our services.

Buserelin is the first injection given and is used to suppress the hormones temporarily before ovarian stimulation begins. These injections are started during the luteal phase of the menstrual cycle (approximately 21st day) and continued till the one is ready for egg collection. The Injections are given at the same time every day. After 2 weeks of continuing these injections, the blood test should be taken to test the oestrogen and luteinizing hormone. Once the test results are satisfactory, it is advised to start stimulation injection which is of different types. Some common drugs are Gonal F, Bemfola and Menopur which are similar in their effects. These injections encourage the development of follicles in each ovary. These injections are taken along with the Buserelin injection. Then the monitoring starts from the 8th day of stimulation. For every 2 or 3 days, the blood test is to be taken for checking the oestrogen levels which indicates how ovaries are responding to the drugs. This will be continued still 3 or more follicles are at the optimum size of 17-20 mm. Usually, it takes 10 – 14 days. After stimulation, a final injection called Pregnyl is to be taken, which helps to mature the eggs. This injection is taken approximately 35 – 36 hours before egg collection. If the injection is not given at the specific time, consult the specialist. At the time of egg collection, the fresh semen sample is to be provided by the partner for ejaculation. After egg collection, the team informs about the details of eggs that are fertilized and to get ready for embryo replacement.

Don’t forget!
  • Nothing to eat or drink from midnight the night before your egg collection.
  • If you are storing embryos your partner is to abstain from ejaculation for 2-4 days before the day of egg collection.
The First Injection details are given below:

Buserelin 

What does it do?

Buserelin is a drug that causes ovarian suppression.  It stops the production of natural hormones that control the release of eggs from the ovaries by acting on the pituitary gland in the brain.

Possible side effects:
  • Mood swings.
  • Hot flushes.
  • Vaginal dryness.
  • Headaches.
  • Nausea.
  • Local irritation at the injection site.
How to use Buserelin:
  1. Remove Buserelin vial from the box.
  2. Flick the blue cap of the lid (this does not need to be replaced afterward).
  3. Take out a needle from the pack you were given.
  4. Remove the orange cap from the needle.
  5. Pierce grey bung of Buserelin with the needle.
  6. Tip the vial upside down.
  7. Pull down the plunger to just past your required dose.
  8. Remove the needle from the vial.
  9. With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
  10. Pull the plunger down and push out the air, ensuring the top of the black plunger lines up with your required dose.
  11. Pinch an inch of fat below your belly button.
  12. The needle is to be injected at a 45-degree angle.
  13. Push the plunger to give yourself the whole injection.
  14. Remove the needle and dispose of it in the sharps bin that you have been provided with.
  15. Put the remaining Buserelin in the refrigerator.
Storage Information

If Buserelin is once opened, it should be stored in a refrigerator.

Types of Stimulation Drugs are below:

Menopur  

What does it do?

Menopur with the aim of an egg developing within each follicle stimulates in ovaries.

Possible side effects:
  • Local irritation at the injection site.
  • Ovarian Hyperstimulation Syndrome (OHSS).
Signs/symptoms to look out for include:
  • Abdominal swelling/pain.
  • Shortness of breath.
  • Extreme thirst.
  • Nausea/vomiting.
  • Headaches.
  • Problems passing urine (small amounts or none at all).
  • Local irritation at the injection site.
How to prepare Menopur:
  1. Remove the product from the box.
  2. Open the top tray, which will contain pre-filled syringes of water, a vial of powder and a needle.
  3. Remove the powder vial from the tray.
  4. Flick the blue cap off.
  5. Remove the grey lid off the pre-filled syringe of water and twist the orange needle on to the top.
  6. Push the needle through the grey bung on the powder vial.
  7. Push all the water into the vial of powder. If you have two pre-filled syringes of water, remove the needle from the first syringe and attach it to the second and inject it into the vial of powder.
  8. The powder should all dissolve. If not completely dissolved, give the vial a gentle roll. Do not shake.
How to inject Menopur:
  1. Take a needle from the large box.
  2. Remove the clear lid.
  3. Pierce the grey bung and tip the vial upside down.
  4. Pull down the plunger to just past your required dose.
  5. With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
  6. Pull the plunger down and push out the air, ensuring the top of the black plunger lines up with your required dose.
  7. Pinch an inch of skin below your belly button.
  8. Inject at a 45-degree angle.
  9. Inject the full dose.
  10. Remove the needle.
  11. Dispose in sharps bin provided.
  12. The remaining solution of Menopur can be stored for the next dose.
Storage Information

Store in a refrigerator (2°C - 8°C) before reconstitution, in its original container to protect from light. The solution may be stored for a maximum of 28 days at not more than 25°C after the reconstitution and also don't freeze.

Gonal F

What does it do?

Gonal F is an injection that contains the follicle-stimulating hormone (FSH). It stimulates your ovaries to produce follicles, aiming to produce an egg inside each one.

Possible side effects:
  • Local irritation at the injection site
  • Ovarian Hyperstimulation Syndrome (OHSS)
Signs/symptoms to look out for include:
  • Abdominal swelling/pain.
  • Shortness of breath.
  • Extreme thirst.
  • Nausea/vomiting.
  • Headache.
  • Problems passing urine (small amounts or none at all).
  • Local irritation at the injection site.
How to use Gonal F:
  1. Take out the Gonal F pen and one of the needles inside your box.
  2. Take the white lid off the Gonal F pen.
  3. Peel the paper cap off the needle.
  4. Twist the needle on the top of the Gonal F pen.
  5. Remove white cap off the needle.
  6. Look in the black window at the end of the pen (there should be a ‘0’).
  7. Twist the red end of the pen till you can see your required dose in the black box.
  8. Remove the green lid on the needle.
  9. Pinch an inch of fat below your belly button.
  10. Inject Gonal F at a 90-degree angle.
  11. Push the red plunger down and hold for 10 seconds.
  12. Remove pen and look in the black window (it should read ‘0’ if you have injected the full dose).
  13. Replace the white cap on the needle and unscrew it off the pen.
  14. Dispose of the needle into the sharps bin provided.
  15. Replace the lid of the Gonal F pen and store as advised below.
Storage Information

Store Gonal F in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum of 28 days.

Bemfola

What does it do?

With the aim of an egg developing within each follicle, Bemfola stimulates the follicles in your ovaries,

Possible side effects:
  • Local irritation at the injection site.
  • Ovarian Hyperstimulation Syndrome (OHSS).
Signs/symptoms to look out for include:
  • Abdominal swelling/pain.
  • Shortness of breath.
  • Extreme thirst.
  • Nausea/vomiting.
  • Headaches.
  • Problems passing urine (small amounts or none at all).
How to use Bemfola:
  1. Take the syringe and needle out of the box.
  2. Remove the peel tab from the injection needle after washing your hands.
  3. Gently push after aligning the injection needle with the pen.
  4. Remove the outer needle protection cap.
  5. Remove the inner needle protection cap.
  6. Hold the pen with the needle pointing upright to make eventual air bubbles rise.
  7. Push the dosage plunger until it stops and a small amount of fluid is seen. If a small amount of fluid is not seen the pen should not be used.
  8. Turn the dosage plunger until the prescribed dose is aligned with the middle of the indent.
  9. Pinch an inch of fat below your belly button.
  10. Inject Bemfola at a 90-degree angle.
  11. Push the plunger until it stops.
  12. Remove the injection needle after 5 Sec.
  13. Dispose of the needle into the sharps bin provided.
Storage

Store Bemfola in the refrigerator and in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum of 28 days.

The information about the Final Injection is below:

Pregnyl

What does it do?

Pregnyl is your final injection and is used to mature the egg within the follicle.

Possible side effects:
  • Headache.
  • Feeling restless or irritable.
  • Depression.
  • Breast tenderness or swelling.
  • Local irritation at the injection site.
How to use Pregnyl:
  1. Remove the two glass vials from the box.
  2. The black dot on the bottle is the weakest point of the vial, flick this dot to make the neck of the vial weak.
  3. Put your left thumb underneath the black dot and your right thumb above the black dot.
  4. Firmly snap the top of the vial.
  5. Repeat with the other vial.
  6. Remove syringe and green needle from the packaging.
  7. Twist green needle at the end of the syringe.
  8. Put the needle into the water and pull the plunger to draw up all the water.
  9. Remove the needle from the bottle and put the needle into the vial of powder.
  10. Push all the water into the vial.
  11. Leave to dissolve for a few seconds then pull the plunger back to draw up a dissolved drug.
  12. With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
  13. Twist off the green needle and dispose in sharps bin provided.
  14. Twist on an orange needle and push the plunger up to remove any air.
  15. Pinch an inch of fat below your belly button.
  16. Inject at 45 degrees and push the plunger down to give yourself a full injection.
  17. Remove the needle and dispose into the sharp bin.
Storage Information

Store in a refrigerator until it is time to administer the injection.

Progesterone (luteal support)

Progesterone is given in the form of a rectal or vaginal suppository. What does it do?

Progesterone, the natural female hormone produced in the body is used in IVF treatment. It helps to support the endometrium and possible early pregnancy.

Possible side effects:
  • Diarrhoea.
  • Flatulence.
  • Soreness in the vagina or rectum.
  • Headache.
Leakage after the pessary gets dissolved after using progesterone. Storage Store below 25-degrees centigrade.

Sedation in IVF

During the egg recovery, the surgeon places a scanning probe into the vagina. Then a needle is inserted alongside the probe. The needle is used to suck out the ripen egg where discomfort occurs. Then the person is sedated and not unconscious. During the procedure, she will be fully monitored. The sedation method is the preferable method after the egg recovery process.

Please visit the doctor on the first day of your next period (the day you wake up bleeding). Inform the unit that you are on the short protocol, and you can have the medication at home. Once treatment is accepted, the instructions regarding when to start your injections will be given. On the 2nd or 3rd day, a blood test and ultrasound scan should be taken. The date will be given to start daily stimulation injection. There are different types of stimulation drugs some are Gonal F, Bemfola and Menopur. These injections encourage the development of follicles in each ovary. On the 5th day of stimulation injections, the one should have an additional injection called Cetrotide, which suppresses your Luteinizing Hormone (LH) surge which is used to prevent ovulation. The one should continue both of these injections until advised to stop. If Metformin tablets are prescribed following consultation, please continue to take these until the day of egg collection. For every 2 or 3 days, the blood test is to be taken for checking the oestrogen levels which indicates how ovaries are responding to the drugs. This will be continued still 3 or more follicles are at the optimum size of 17-20 mm. Usually, it takes 10 – 14 days. After stimulation, a final injection called Pregnyl is to be taken, which helps to mature the eggs. This injection is taken approximately 35 – 36 hours before egg collection. If the injection is not given at the specific time, consult the specialist. At the time of egg collection, the fresh semen sample is to be provided by the partner for ejaculation. After egg collection, the team informs about the details of eggs that are fertilized and to get ready for embryo replacement.

Don’t forget!
  • Nothing to eat or drink from midnight the night before your egg collection.
  • If you are storing embryos your partner is to abstain from ejaculation for 2-4 days before the day of egg collection.

Menopur  

What does it do?

Menopur with the aim of an egg developing within each follicle stimulates in ovaries.

Possible side effects:
  • Local irritation at the injection site.
  • Ovarian Hyperstimulation Syndrome (OHSS).
Signs/symptoms to look out for include:
  • Abdominal swelling/pain.
  • Shortness of breath.
  • Extreme thirst.
  • Nausea/vomiting.
  • Headaches.
  • Problems passing urine (small amounts or none at all).
  • Local irritation at the injection site.
How to prepare Menopur:
  1. Remove the product from the box.
  2. Open the top tray, which will contain pre-filled syringes of water, a vial of powder and a needle.
  3. Remove the powder vial from the tray.
  4. Flick the blue cap off.
  5. Remove the grey lid off the pre-filled syringe of water and twist the orange needle on to the top.
  6. Push the needle through the grey bung on the powder vial.
  7. Push all the water into the vial of powder. If you have two pre-filled syringes of water, remove the needle from the first syringe and attach it to the second and inject it into the vial of powder.
  8. The powder should all dissolve. If not completely dissolved, give the vial a gentle roll. Do not shake.
How to inject Menopur:
  1. Take a needle from the large box.
  2. Remove the clear lid.
  3. Pierce the grey bung and tip the vial upside down.
  4. Pull down the plunger to just past your required dose.
  5. With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
  6. Pull the plunger down and push out the air, ensuring the top of the black plunger lines up with your required dose.
  7. Pinch an inch of skin below your belly button.
  8. Inject at a 45-degree angle.
  9. Inject the full dose.
  10. Remove the needle.
  11. Dispose in sharps bin provided.
  12. The remaining solution of Menopur can be stored for the next dose.
Storage Information

Store in a refrigerator (2°C - 8°C) before reconstitution, in its original container to protect from light. The solution may be stored for a maximum of 28 days at not more than 25°C after the reconstitution and also don't freeze.

Gonal F  

What does it do?

Gonal F is an injection that contains the follicle-stimulating hormone (FSH). It stimulates your ovaries to produce follicles, aiming to produce an egg inside each one.

Possible side effects:
  • Local irritation at the injection site
  • Ovarian Hyperstimulation Syndrome (OHSS).
Signs/symptoms to look out for include:
  • Abdominal swelling/pain.
  • Shortness of breath.
  • Extreme thirst.
  • Nausea/vomiting.
  • Headache.
  • Problems passing urine (small amounts or none at all).
  • Local irritation at the injection site.
How to use Gonal F:
  1. Take out the Gonal F pen and one of the needles inside your box.
  2. Take the white lid off the Gonal F pen.
  3. Peel the paper cap off the needle.
  4. Twist the needle on the top of the Gonal F pen.
  5. Remove white cap off the needle.
  6. Look in the black window at the end of the pen (there should be a ‘0’).
  7. Twist the red end of the pen till you can see your required dose in the black box.
  8. Remove the green lid on the needle.
  9. Pinch an inch of fat below your belly button.
  10. Inject Gonal F at a 90-degree angle.
  11. Push the red plunger down and hold for 10 seconds.
  12. Remove pen and look in the black window (it should read ‘0’ if you have injected the full dose).
  13. Replace the white cap on the needle and unscrew it off the pen.
  14. Dispose of the needle into the sharps bin provided.
  15. Replace the lid of the Gonal F pen and store as advised below.
Storage Information

Store Gonal F in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum of 28 days.

Cetrotide  

What does it do?

The natural hormone which is called Gonadotropin-Releasing Hormone (GnRH) is effected by the blockage by cetrotide. GnRH controls the secretion of another hormone called luteinizing hormone (LH) which induces ovulation during the menstrual cycle.

Possible side effects:
  • Mood swings.
  • Hot flushes.
  • Headaches/nausea.
  • Vaginal dryness.
  • Local irritation at the injection site.
How to use Cetrotide:
  1. Remove from packaging.
  2. Remove blue cap from vial of powder.
  3. Take a pre-filled syringe of water and remove the cap.
  4. Attach the yellow needle (larger needle) on the end of the pre-filled syringe of water.
  5. Pierce the grey bung with the needle and push all of the water into the vial.
  6. Draw up all the solution back into the syringe once the powder has been completely dissolved.
  7. Remove the large yellow needle and dispose in sharp bin provided.
  8. Attach on a grey smaller needle.
  9. With the needle pointing towards the ceiling, flick the syringe so that any air bubbles move to the top.
  10. Push the plunger up so no air is in the syringe.
  11. Pinch an inch of fat below your belly button.
  12. Inject at 45-degree angle.
  13. Push the plunger down to administer Cetrotide.
  14. Dispose of needle and syringe into a sharps bin.
Storage information:

Keep in the box in a dry cool place.

Pregnyl 

What does it do?

Pregnyl is your final injection and is used to mature the egg within the follicle.

Possible side effects:
  • Headache.
  • Feeling restless or irritable.
  • Depression.
  • Breast tenderness or swelling.
  • Local irritation at the injection site.
How to use Pregnyl:
  1. Remove the two glass vials from the box.
  2. The black dot on the bottle is the weakest point of the vial, flick this dot to make the neck of the vial weak.
  3. Put your left thumb underneath the black dot and your right thumb above the black dot.
  4. Firmly snap the top of the vial.
  5. Repeat with the other vial.
  6. Remove syringe and green needle from the packaging.
  7. Twist green needle at the end of the syringe.
  8. Put the needle into the water and pull the plunger to draw up all the water.
  9. Remove the needle from the bottle and put the needle into the vial of powder.
  10. Push all the water into the vial.
  11. Leave to dissolve for a few seconds then pull the plunger back to draw up a dissolved drug.
  12. With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
  13. Twist off the green needle and dispose in sharps bin provided.
  14. Twist on an orange needle and push the plunger up to remove any air.
  15. Pinch an inch of fat below your belly button.
  16. Inject at 45 degrees and push the plunger down to give yourself a full injection.
  17. Remove the needle and dispose into the sharp bin.
Storage Information

Store in a refrigerator until it is time to administer the injection.

Metformin 

What does it do?

Metformin is prescribed during IVF treatment for some people with Polycystic Ovary Syndrome (PCOS) or those with a high ovarian reserve. The use of Metformin can help to reduce the risk of Ovarian Hyperstimulation Syndrome (OHSS).

Possible side effects:
  • Diarrhoea.
  • Nausea/vomiting.
  • Abdominal pain.
  • Loss of appetite.
Storage information

Keep Metformin in the packaging in a cool, dry place.

Progesterone (luteal support) 

Progesterone is given in the form of a rectal or vaginal suppository.

What does it do?

Progesterone, the natural female hormone produced in the body is used in IVF treatment. It helps to support the endometrium and possible early pregnancy.

Possible side effects:
  • Diarrhoea.
  • Flatulence.
  • Soreness in the vagina or rectum.
  • Headache.
Leakage after the pessary gets dissolved after using progesterone. Storage Store below 25-degrees centigrade.

Bemfola

What does it do?

With the aim of an egg developing within each follicle, Bemfola stimulates the follicles in your ovaries,

Possible side effects:
  • Local irritation at the injection site.
  • Ovarian Hyperstimulation Syndrome (OHSS).
Signs/symptoms to look out for include:
  • Abdominal swelling/pain.
  • Shortness of breath.
  • Extreme thirst.
  • Nausea/vomiting.
  • Headaches.
  • Problems passing urine (small amounts or none at all).
How to use Bemfola:
  1. Take the syringe and needle out of the box.
  2. Remove the peel tab from the injection needle after washing your hands.
  3. Gently push after aligning the injection needle with the pen.
  4. Remove the outer needle protection cap.
  5. Remove the inner needle protection cap.
  6. Hold the pen with the needle pointing upright to make eventual air bubbles rise.
  7. Push the dosage plunger until it stops and a small amount of fluid is seen. If a small amount of fluid is not seen the pen should not be used.
  8. Turn the dosage plunger until the prescribed dose is aligned with the middle of the indent.
  9. Pinch an inch of fat below your belly button.
  10. Inject Bemfola at a 90-degree angle.
  11. Push the plunger until it stops.
  12. Remove the injection needle after 5 Sec.
  13. Dispose of the needle into the sharps bin provided.
Storage

Store Bemfola in the refrigerator and in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum of 28 days.

Sedation in IVF 

During the egg recovery, the surgeon places a scanning probe into the vagina. Then a needle is inserted alongside the probe. The needle is used to suck out the ripen egg where discomfort occurs. Then the person is sedated and not unconscious. During the procedure, she will be fully monitored. The sedation method is the preferable method after the egg recovery process.

Other options

If the sperm is not suitable for the long term, please approach the specialists after getting an appointment.

How are the samples produced and stored?

Samples are collected and stored in bottles sealed with liquid nitrogen vapor and labeled with name and contact details. Then the freezing process takes place.

Can my wife/partner accompany me?

Yes. You may be accompanied by anyone you choose.  You can also be seen alone if you prefer.  The sample is checked for quality and then it will be frozen. If you wish, we can offer you further appointments at this time.

How long can sperm be stored?

According to law, sperm can be stored for 55 years. So it is important that you keep us updated with any changes in your details so that we can contact you every 10 years.

What if something goes wrong with storage?

Any hospital does not guarantee against all the eventualities. For example, in the event of a strike or civil disturbance interrupting the supply of liquid nitrogen, or in the event of equipment failure.

How are the samples used?

There are many options to have treatment. The main ones are: • IUI Intra-Uterine Insemination • IVF (In-vitro Fertilization) • ICSI Intra Cytoplasmic Sperm Injection All these will be explained to you by the doctor when you are ready to start a family.

How successful are these treatments?

Different methods have different success rates. Standard gynecological tests on your wife/partner would normally be arranged. recommended before using your stored semen, and these can be Frozen sperm, however, it is not as fertile as fresh sperm and we are unable to guarantee that a pregnancy will result from its use.

Counseling

Infertility counseling is available at Prasad Hospitals and appointments to see the counselor can be arranged. The time of banking may be stressful for you and your future fertility may be the last thing on your mind. Later on, you may well want to consider your options, and take time to go through them. Even if you are not ready to start a family, you can, if you wish, be given an appointment to discuss the situation.

Family Planning During Treatment

Even not having any proof regarding that radiotherapy/chemotherapy causes changes to the sperm that affect any children conceived during treatment, it is advisable to use a form of contraception during the treatment and for 12 months after it finishes.

What is the IONA® test?

The IONA test is a prenatal test done for pregnant women which are for estimating the risk of the fetus having serious genetic diseases. It is an advanced test where screening is carried out on a small maternal blood sample. The patients can expect the results within 3 – 5 days approximately.

What does the IONA® screen for?

The IONA® test estimates the risk of a fetus having Down’s syndrome (Trisomy 21), Edwards’ syndrome (Trisomy 18) and Patau’s syndrome (Trisomy 13). Trisomy occur when three copies of a chromosome are present instead of two. Edwards’ and Patau’s syndromes are very rare but Down’s very serious and many affected babies haven’t survived.

What are the advantages of the IONA® test?

  • Safe: IONA test is non-invasive with no risk of miscarriage.
  • Fast: IONA® test is the fastest test available with results provided within 3-5 working days, from sample receipt.
  • Accurate: For About 99% for the detection of trisomy conditions, Fetal sex determination is greater than 97% accurate.
  • Simple: This test uses a simple maternal blood sample.
  • Local: Unlike other Non-Invasive Prenatal Tests (NIPT), the IONA® test is performed in a laboratory local to you.
  • Quality: The IONA® test is a regulated diagnostic, which is CE marked.

How does it work?

During the pregnancy, the leakage of cell-free by the placenta circulates in the maternal bloodstream. As a result, a maternal blood sample contains a mixture of fetal and maternal circulating DNA. This IONA test directly measures this DNA quantity and also detect the DNA ratio when a fetal trisomy 21, 18 or 13 is present.

Why is IONA® better than the combined test?

During the pregnancy, the traditional screening is offered which is called a combined test. It is an ultrasound scan which measures the nuchal translucency and a blood test. But it is not as accurate as NIPT where it detects around 85% of babies with Down’s Syndrome. IONA test has a higher detection rate than the combined test.

Who can have the IONA® test?

  • Suitable for women who are at least 10 weeks pregnant.
  • Suitable for all singleton and twin pregnancies.
  • Suitable for IVF or surrogate pregnancies.
  • This test is not suitable for women with cancer or who have undergone blood transfusion within the last 12 months or with a trisomy.

How are the IONA® results reported?

  • Low Risk: It is very unlikely to have the risk of pregnancy affected by trisomy 21, 18 or 13.
  • High Risk: It means pregnancy is at increased risk for trisomy 21, 18 or 13 and the result should be confirmed by follow up invasive procedures.
  • No Result: In very rare cases there is insufficient fetal DNA in the sample to obtain a result. An additional blood sample is taken.

About Prasad Hospitals:

The IONA® test is developed and manufactured by Prasad Hospital, a UK molecular diagnostics company based in Manchester. Our mission is to develop molecular diagnostic products that will have a positive impact on human health.

Introduction

For assessment of sperm quantity and quality, a semen sample should be provided.

Delivery of your sample

As a fresh sample is essential for this test, it must be brought to the laboratory within one hour of being passed at home.

Instructions for collecting the semen sample

  • You should abstain from intercourse or masturbation for three to four days before providing the specimen.
  • The sample should be obtained by only masturbation and collected directly into the specimen container. A condom or artificial lubrication must not be used for semen collection as it will kill the sperm.
  • The complete specimen is needed for this examination, so if any of your specimen is spilt you must tell us, as a repeat specimen is required.
  • Label the specimen container with your full name, date of birth and the date and time the specimen was passed.
  • Ensure the top is screwed on tightly so that it does not leak and then place the container into the biohazard bag.

Sample identification

  • Please make sure that your name, date of birth and the requesting Doctor’s details are on the request form provided.
  • Make sure that the date and time of collection are entered on the specimen details form on page 7 of this booklet.
  • Please ensure that your full name and date of birth are on the label of the specimen container. We cannot process unlabeled or poorly labeled samples.

Delivery of your sample

  • Deliver the sample to the Department of Reproductive Medicine, Prasad Hospital within one hour of passing the sample.
  • Keep the sample at body temperature while being transported to the laboratory.  Excessive cold or heat may damage the sperm.
  • Specimens will only be accepted between 8.30 am and 3.00 pm Monday to Friday (Opening hours: Monday – Friday: 8.30 am to 4.00 pm).

About one man in a hundred produces no sperm (10-15% of all sub fertile men) - a condition known as azoospermia.  Various factors can contribute towards these conditions, some of which may be inherited. To achieve pregnancy, surgically retrieved sperm are used in an IVF/ICSI treatment cycle.

What is Surgical Sperm Retrieval (SSR) and what does this treatment involve? 

Surgical Sperm Retrieval is a technique used for collecting sperm directly from a man’s testicles or epididymis. It is a procedure usually carried out as a day case under general anesthetic. An SSR is usually planned, but in exceptional circumstances can also be carried out as an emergency procedure. This would usually be if the man is unable to produce a sperm sample on the day of his wife’s or partner’s egg collection. The procedure is carried out under general or spinal anesthetic or with sedation. The team may use different sperm retrieval methods. The method is determined according to the FSH level and testicular size. Your surgeon will advise you which procedure will be suitable for you.

Who may benefit from Surgical Sperm Retrieval (SSR)?

This method is helpful to a man who has low-quality sperm or no sperm in their ejaculate. This can be the result of several causes:

  • Men who have had a vasectomy (the male sterilization operation), that is, removal of vas deferens (the tube which carries the sperm to the penis) or a failed vasectomy reversal.
  • Men who are carriers of certain genetic conditions, such as cystic fibrosis.  These men do not have a vas deferens or a blockage in the epididymis
  • Men who cannot produce sperm in their semen.
  • History of any testicular surgery and undescended testes.
  • Illness (such as mumps in adolescence affecting the testis).
  • May be suitable for men with a spinal injury and where there are problems with normal ejaculatory function (such as Multiple sclerosis, Diabetes).
  • Men with congenital or acquired endocrine conditions.
  • Men with a genetic condition like Klinefelter syndrome.
  • Medications like steroids, testosterone.

Most of the men produce healthy sperm in the testicles which can be retrieved by SSR. Unfortunately, some men have the testicles that fail to produce any sperm.

Pre-operative (pre-op) appointment

Once you are listed for SSR, you will be sent a separate appointment to see a consultant to sign both the HFEA consent forms and a surgical consent form. This appointment will be held in the Department of Reproductive Medicine. You will also be invited to attend a pre-op assessment, usually 1-2 weeks before your surgery date.

What are the different methods of SSR?

There are different methods of SSR.  The cause of your azoospermia will determine the best way to retrieve sperm in your case.

1. Percutaneous Epididymal Sperm Aspiration (PESA)

PESA is performed in theatre at the Prasad Hospitals, under sedation. It is a short, relatively painless procedure and requires no surgical incision. It is the least invasive method and involves inserting a fine needle into the epididymis, from which fluid is aspirated. Embryologists then inspect the fluid under a microscope for sperm motility and content which takes about 30 minutes. If the aspirates fail to show any viable sperm then the surgeon will proceed to the other options (TESE), usually on another day. This is particularly suitable for men who have had a vasectomy, obstruction or who were born without a vas deferens (cystic fibrosis). We will inform you of the outcome of the PESA procedure on the day of the procedure.

2. Testicular Sperm Aspiration (TESA)

A fine needle is used with a biopsy gun to remove small lengths of seminiferous tubule (sperm-producing tubules). These are then carefully dissected under a microscope by embryologists.

3. Micro-epididymal Sperm Aspiration (MESA)

Instead of using a needle in PESA, a small cut is made through the scrotum and into the epididymis. The fluid is collected and taken for microscopic examination by embryologists to see whether there is any viable sperm or not.

4. Testicular Sperm Extraction (Open conventional TESE)

TESE will be performed if-else no sperm is found in PESA, TESA or MESA.  This procedure is performed in the Prasad Hospitals. TESE can be performed by

  • Single biopsy (unifocal): If the hormone level and testicular size are normal, then a small incision is made into the testis itself.  A small sample of testicular tissue is taken which is then examined for sperm. Stitches are applied that are dissolvable and so will not need to be removed.  Pain relief is given in the form of a local anesthetic and nerve block to the genital region.
  • Open scrotal exploration and multifocal testicular biopsies: This involves performing a midline or horizontal incision on the scrotal skin. Three to four biopsies are taken from each testicle in different areas. Stitches are applied that are dissolvable and so will not need to be removed. Pain relief is given in the form of local anesthetic and nerve block to the genital region. This provides pain relief for 15-16 hours. This procedure will cause some pain and tenderness afterward, however, full recovery is expected within a few days. It is not possible to tell you on the day if sperm were present in the biopsy material, as it may require special culture technique. It may take 3-5 days before the embryologist will be able to give you any information about the presence or absence of sperm in the biopsy material. This result will be informed to you in the clinic appointment, usually in 1-2 weeks.

Effectiveness of SSR

Surgically retrieved sperm, if viable, are stored frozen and this does not affect their ability to subsequently fertilize an egg.  Surgically retrieved sperm (SRR) is not comparable to normally ejaculated sperm.  As the number of sperm retrieved by surgical means is usually low in numbers with reduced motility and may not be mature, and therefore cannot successfully fertilize an egg using IVF techniques.  Because of this, the embryologist will pick out a single sperm to inject into each egg, this procedure is called Intracytoplasmic Sperm Injection, (ICSI).  Fertilization rates are dependent upon the quality of sperm and eggs.  If non-motile sperm are all that are available for selection, it is impossible to tell whether the sperm is alive or dead, so fertilization rates will be adversely affected.  It is also possible that no sperm at all will be obtained after the stored frozen sperm is thawed.

Possible Complications

SSR is a relatively low-risk procedure.  Possible complications include pain, bleeding, infection, hematoma (swelling of testicles with blood in the testicle) that would require immediate exploration of the testicle within a few hours of surgery.  The risk of these complications occurring is small.  There is a very small risk of testicular damage and chronic testicular pain, but these occur rarely.  Any procedure that requires a general anesthetic also carries an increased risk of complications of anesthesia.

Preparing for SSR

Before coming to the hospital (24 hours prior) you should shave all the hair off the scrotum or use a cream depilatory. You should bring with you a tight pair of ‘slip’-style underpants or swimming trunks – not boxer shorts. You will need to be accompanied by a driver or to arrange a lift/taxi as you will not be able to drive for 24 hours after the procedure.

Before your procedure

You will be required to fast (this includes no chewing gum and sucking on sweets) for at least 6-8 hours before the procedure.  You are also advised to avoid alcohol for at least 24 hours.

After your procedure

You will be able to leave the unit about four hours after the procedure. As with any surgical procedure, there is a slight risk of bleeding, bruising or infection. In order to reduce this risk, we would advise you to wear reasonably tight-fitting pair of underpants rather than boxer shorts for at least 48 hours (including overnight) from the day of your operation and then wear your own scrotal support (jock strap) daily (changing every day) for further 12 days to minimize discomfort and protect your scrotum and testes. Showering is advised and avoid hot baths to prevent infection. You should avoid alcohol, taking drugs that contain aspirin and refrain from strenuous exercise for a few days after SSR. Sexual activity is not advised for a week after the procedure. If you had an open SSR procedure you would be advised to be off work for 7-14 days. If you experience any discomfort, you may take up 4g (usually 8 tablets) of paracetamol, or 240mg codeine, or 1200mg ibuprofen in any 24 hours. You should follow the information on the medication to ensure you do not exceed the recommended dosage in any 24 hours.

What is Surrogacy?

Surrogacy is when the couple who are unable to conceive, can have a baby from another woman. The intended parents are the ones who become the legal parent of a child who is born through surrogacy. There are two types of surrogacy:

  • Traditional Surrogacy: Traditional surrogacy is where the surrogate is genetically related and becomes pregnant through artificial insemination.
  • Host surrogacy: It is when IVF is used, either with the eggs of the intended mother or with donor eggs. The surrogate mother is not genetically related to the baby and does not use her eggs. The three stages of this type of surrogacy are
    • Egg Donation: The female egg donor undergoes some special procedures to extract many eggs.
    • Fertilization: The eggs are fertilized with sperm in the laboratory, resulting in embryos.
    • Embryo Transfer: The embryo is transferred into the womb of the surrogate mother. The Embryo Transfer can be transferred to the surrogate either fresh or after have been de-frosted from storage. For a fresh embryo transfer, the cycles of the surrogate and the egg donor must be synchronized, and this is done using hormone medications. In cases where embryos have been frozen already and the de-frosted embryos are being transferred, the surrogate mother is provided with hormone medications to ‘ready’ her womb lining.

    The Birth Mother

    Now, according to the law, the woman who gives birth to the child can be treated as a legal mother and have parental responsibility.

    The Intended Mother

    The woman cannot be treated as the mother of the child even her eggs are used in the treatment. She has no legal rights concerning the child by her eggs being used or under any surrogacy agreement.

    The Father

    The child’s legal father will be the surrogate’s husband unless:

    • The surrogate’s husband didn’t give their permission for their wife to carry the pregnancy.
    • If your surrogate has no partner, or they are unmarried, the child will have no legal father or second parent.

    Consents

    From 1st October 2013, it is possible for one of the intended parents commissioning a surrogacy arrangement to be recognized as the legal parent when the child is born if the surrogate is not married and the relevant consents are in place. These consents will be completed with the couple at the hospital with a doctor’s appointment.

    Screening

    Before the treatment, screening of all those involved in surrogacy arrangements will be undertaken in line with HFEA's current guidelines can be provided.

    Funding

    The clinical commissioning groups (CCGs) do not currently provide surrogacy on the NHS.

The ultrasound scan is an important part of Reproductive Medicine assessments. It gives the information about the lining of the womb and the number and size of follicles, and any existing pathology, such as cysts or fibroids. This helps to decide the further stages of treatment.

Does it hurt?

Ultrasound scans are not painful and are internal. The scans involve a special probe, which is cleaned before use, that be inserted into the vagina. Some patients may find it a little uncomfortable, but it is not as bad as a smear test.

Why vaginally? 

The ultrasound scans are performed transvaginally because they can be done with an empty bladder. The scans provide a better image of the pelvic organ. It is important that you have an empty bladder for this test.  Please go to the toilet before your scan.

How long will it take? 

The examination will take approximately 10 minutes. It is not painful. A probe is inserted into the vagina. The womb and ovaries can be seen on the screen. The scan will be performed by a sonographer (a medical professional trained to use diagnostic scanning equipment) or a doctor.

Will I have to undress?

Yes, you have to undress from the waist down and lie on the ultrasound couch and also to bend knees to insert the ultrasound probe.

When are the scans performed and what are you looking for?

There are many scans to be taken during the treatment and the fist scan should be done at any time of the menstrual cycle. This scan is called a ‘baseline’ scan and is to document any pathology within the uterus or ovaries before the treatment begins. The ones who are using stimulation drugs, have to get repeated scan and blood tests at an interval of 2- 3 days till the size of the needed follicle is measured.

Can my partner stay with me?

You can bring your partner into the scan room. On some days there may be a Trainee in the ultrasound room, either to just watch the scan or to have practice at scanning but we will ask your permission first.

What if I am unsure about something?

To help you understand what we say, we have listed some words with explanations below:

  • Endometrium: The lining of the womb. We measure this each time you are scanned. It is thin when you are on your period and thickens in response to the medication or your menstrual cycle.
  • Uterus: the womb.
  • Follicles: These are in the ovaries and are what develop eggs as they grow. The follicles grow in response to the medication. The follicles need to be a certain size before you are ready to go to the theatre for egg retrieval, Intrauterine Insemination or Induction of Ovulation.
  • Cysts: These are little sacs of fluid, blood or other components. Sometimes we see them on the baseline scan.
  • Hydrosalpinx:  It can be a side effect of the medication or when associated with blocked fallopian tubes.
  • Fibroids: Thickened lumps of muscle within the muscle of the uterus.
  • Polyps: Benign (non-cancerous) growths that can be found on the lining of the womb and may cause problems with the embryo implanting easily.

What are unborn baby's normal movements in pregnancy? 

Most women, when they are 18–20 weeks pregnant, can first aware of their baby moving. However, if this is the first pregnancy, a woman may not become aware of movements for more than 20 weeks pregnant. Unborn baby’s movements as a kick, flutter, swish or roll can be felt by a pregnant woman. As the baby develops, the movements type changes. During the afternoon, evening, baby movements are felt more. During day and night, the baby may have sleep periods for mostly 40 minutes. The number of movements tends to increase until 32 weeks of pregnancy and then stay about the same, although the type of movement may change as you get nearer to your due date.

Why are my unborn baby’s movements important?  

If the baby’s movements get slowed or stopped, it implicates that the baby is not well. Around 50% of women notice the baby’s movements. Don’t use Doppler or phone apps to check the baby’s heartbeat.

How many movements are enough?

Every baby has a pattern of movements as there is no set number of normal movements. From 4-6 months, pregnant women can feel the baby movements more and stay up to 8 months and then stay roughly until giving birth.

What factors can affect the pregnant woman feeling her baby move?

If the pregnant woman is active or busy, she can be very less likely to be aware of the baby’s movements. Your baby lying head down or bottom first will not affect whether you can feel it move. If the baby’s back is lying at the front of the uterus, she may feel fewer movements than if the baby back is lying alongside her back.

What can cause baby movements to reduce?

The baby movements can be lower, when
  • Drugs like pain relief or sedatives are used.
  • Alcohol consumption and smoking.
  • When the pregnant woman is unwell.

Should the woman use a chart to count her unborn baby’s movements?

Different babies have a different pattern of movements. The pregnant woman can get aware of the baby movements' frequency throughout the pregnancy. If she feels the movements are reduced, approach the doctor immediately.

What if the woman is unsure about her baby’s movements?

If a pregnant woman feels or unsure about the decrease in baby movements, the women should lie down on the left side to focus on the baby’s movements for 2 hours. If not more than 10 movements aren’t felt, immediately approach the doctor.

What to do if I feel my baby’s movements are reduced or changed?

Always seek doctors to help immediately. Never neglect a reduction in your baby’s movements.

  • For less than 24 weeks – Generally, the baby movements can be felt from 18 – 20 weeks, if the woman doesn’t feel it, visit the doctor for a checkup. The doctor checks the baby’s heartbeat. An ultrasound scan will be arranged to check the baby’s wellbeing.
  • During 24 – 28 weeks of pregnancy – The tests like baby’s heartbeat, having an antenatal checkup, size of the uterus, blood pressure level, protein levels testing from urine are done by the team. If the uterus is smaller, an ultrasound scan is used to check the baby’s growth.
  • Over 28 weeks of Pregnancy – During this time, do not neglect the baby’s movements. Approach the doctor immediately if the baby’s movements are reduced. The baby’s heartbeat will be monitored for at least 20 minutes. An ultrasound scan is arranged to check the growth and amount of amniotic fluid around the baby, if
  • The uterus is smaller than expected.
  • Pregnancy risk factors.
  • Heart rate is normal but still, feels less than normal baby’s movements.

 What to do if the woman finds her baby’s movements are reduced again?

If the baby’s movements are slowed down even after the checkup, don’t hesitate to take the advice from the team.

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