First & Only NABH-Accredited Hospital In Nacharam


  24X7 Emergency Helpline : +9188012333333

Information For You

Before egg recovery

You are now ready for egg recovery. As usual, the nurses will ring you to inform you of your drug doses.

In order to complete egg maturation, a HCG injection must be given subcutaneously (under the skin) 34-36 hours before egg recovery. The date and time of this injection will be confirmed by the nurses, along with the time of your egg recovery. It is very important that you take the injection in the time period stated. The next day we do not need to see you and you will not need any injections.

You should have nothing to eat or drink from midnight before the egg recovery nor should you chew gum.

 

Please report to the IVF reception on the ground floor between 7.30 and 7.45 am on the morning of your egg recovery.  The staff will direct you to Ward 90.

We recommend that you bring a dressing gown, slippers, your toilet bag and some reading material to occupy you. An embryologist will see you before you are discharged. You will need somebody to take you home and stay with you overnight.

Following your operation you may feel tired, bloated, have mild abdominal pain and light vaginal bleeding for some days.  You should plan to have at least a couple of days off work to recover.

We wish you the very best of luck.

If you are admitted to another hospital following your egg recovery, it is essential that you inform the Unit.

 

After egg recovery

We hope your egg recovery was successful and that you are feeling well.

You should try to rest over the next few days. You may feel tired and have mild period-like pains and some vaginal bleeding. Paracetamol is a safe drug to use for pain relief. Sanitary towels should be used, not tampons.

Please contact the nurses on the Unit if you experience any persistent sickness, vomiting, severe pain, thirst, swelling of your abdomen or a reduction in the amount of urine you are passing, as these symptoms may indicate ovarian hyperstimulation (OHSS).

On leaving Ward 90 you will have been given some Cyclogest pessaries. The nurse will have explained how and when to use these. They are to start on the first day following your egg collection (egg collection day being ‘day 0’). One pessary is inserted vaginally first thing in the morning and another one last thing at night.

On the day of embryo transfer, please do not use the morning pessary until after the transfer.

Please wait for the embryologists to confirm your transfer date before using a pessary that day.

Your pessaries will continue until the date you do a pregnancy test.

If the test is positive, you will continue  the pessaries up to your scan date.

If the test is unfortunately negative, you will be asked to stop using them.

Please do not hesitate to ask if you have any questions.

In the event of an emergency outside of working hours, please telephone  on +9188012333333

What time do I arrive?

On the day of your operation, please report to reception. The nursing staff will then advise you where your bed will be located.

What do I need to bring?

You should bring slippers, socks, dressing gown and toiletries with you and something to pass the time. You should also bring some firmly supportive jock strap style underpants. You will need to wear this style of underpants for the first 48 hours after your operation.

What happens next?

Your consultant and anaesthetist will see you before your operation to ask you to sign the necessary consent form and answer any final questions you may have. Your partner may telephone the nursing staff on the ward where you have been admitted after midday to enquire about your operation.

How long do I need to stay? 

You can expect to be in hospital until approximately 5.00 pm. Your consultant will come to see you after the operation to explain the findings and to ensure that you are fit for discharge home. Your condition will be checked by one of the IVF medical or nursing team to see you have sufficiently recovered from your anaesthetic. 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 are able to walk steadily without assistance. You will be able to go home by late afternoon or early evening if all is well. 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 hospital.

Are there any precautions I should take after the operation? 

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

What should I expect following surgical sperm recovery? 

You should be able to leave 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 minimise 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 room at your GP’s surgery or here in the IVF clinic. The free ends of your skin stitches will have been left long to simplify their removal if necessary. 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.

What are the possible complications after surgical sperm recovery? 

The most common complications are infection or a haematoma (a collection of blood) within the scrotum. Both of these may cause pain, usually within 2-4 days after the procedure.  Infection will usually cause increasing tenderness and there may be cloudy discharge from around the dissolvable stitches in your scrotum. A haematoma will usually cause a swelling and deep purple discolouration but the risk of this is minimised 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 or your own GP. Out of hours you can contact the hospital on: +9188012333333  (Emergency Gynaecology Unit)

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. Also during the first seven days avoid lifting and protect the wound. You should resume a normal diet and increase your daily activities to a normal level over a 3 to 4 day period. You should abstain from sports activities, heavy lifting and sexual intercourse for approximately 10 days.

What is this leaflet about?

This leaflet is to inform women undergoing endometrial scratch about what is involved. Your consultant will inform you that this procedure may improve your chances of having a baby. Research is still being gathered but it is initially thought to increase pregnancy and live birth rate in a selected group of patients.

What is endometrial scratch? 

Endometrial scratch is a procedure used to help embryos implant more successfully after in-vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI) in patients who had failed cycles despite transfer of good quality embryos. 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? 

Endometrial scratch is performed on women who did not get pregnant after transfer of good quality embryos, and in the absence of any other cause of failed implantation. 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. Endometrial scratching may ‘switch on’ the genes that are responsible for preparation of the endometrium for implantation, which increases 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.
  •  You may eat and drink normally before the procedure. 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.
  •  A speculum is gently inserted into the vagina so the cervix can be seen (similar to having a smear test). The cervix is cleaned with sterile gauze.
  •  A fine, thin plastic tube (flexible catheter) will then be passed through the opening of the cervix into the cavity of the uterus to gently and superficially scratch the lining of the uterus. (Inserting and moving the catheter up and down may cause mild abdominal cramping similar to period pain).
  •  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 is a small risk that any infection within the cervix may 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.

Welcome to the Gynaecology Services at Prasad Hospital.

This leaflet aims to give you some general information about the procedure of fallopian tube cannulation and help to answer any questions you may have.  It is intended only as a guide and there will be an opportunity for you to talk to your nurse and doctor about your care and treatment.

What is fallopian tube cannulation (by keyhole surgery)? 

Fallopian tube cannulation is a surgical procedure aimed at treating women with subfertility (difficulty conceiving a pregnancy) with proximal tubal occlusion (blockage in the part of the fallopian tubes closest to the womb).

Why is fallopian tube cannulation performed? 

Up to 1 in 6 couples may suffer from subfertility. The reasons behind subfertility are different between couples but in 1 in 5 couples this is because the fallopian tubes are blocked, either completely or partially (tubal factor).  Normal fallopian tube function is important in allowing the egg (oocyte) to meet the sperm for fertilisation (joining of the egg and sperm) and to allow the fertilised egg (embryo) to travel to the womb (uterus).   The common reasons behind a ‘blocked’ fallopian tube include previous infection, scar tissue (adhesions) and endometriosis. Blocked fallopian tubes may be diagnosed either by an X-ray test called a ‘hysterosalpingogram’ or by undergoing an operation called a ‘laparoscopy and dye test’.   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?

You are suitable for fallopian tube cannulation if: 1. You have a history of subfertility due to tubal factor. 2. Tubal blockage has been diagnosed either by hysterosalpingogram or laparoscopy and dye test. 3. The site of the blockage is in the proximal part of the fallopian tube (see diagram) and there is no hydrosalpinx (swollen tubes due to blockage at the end 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 own circumstances. However, in general for couples with subfertility due to the tube factor, the main alternative involves undergoing IVF (in vitro fertilisation).

How is fallopian tube cannulation performed? 

Fallopian tube cannulation is an operation performed by ‘keyhole’ surgery with two cameras, namely by 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 visualising the abdomen and the pelvis through the laparoscope, a fine guidewire is introduced into the womb and the opening of the fallopian tube. This guidewire is then 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 afterwards. (NICE interventional procedures programme 2013).   Specific to our unit in Saint Mary’s Hospital our available data shows fallopian tube cannulation achieves tubal patency in 73 to 79% of women and is successful in achieving a pregnancy in 22 to 33% of cases.

How safe is fallopian tube cannulation? 

Fallopian tube cannulation is generally regarded as 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 higher risk of developing an ectopic pregnancy. If you successfully conceive after this procedure it is important that an ultrasound scan is 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 anaesthetic 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. These may be tender immediately after your operation and for the next 10-14 days. Your nurse will provide you with appropriate pain relief accordingly. It is common to have some mild vaginal bleeding for a few days after your operation. Do not use tampons during this period, only sanitary towels. Tampons may increase your risk of developing an infection. If you feel your bleeding is prolonged or becomes foulsmelling, please seek advice from your GP.

When can I have sex again?

Do not resume having sexual intercourse until any vaginal bleeding has stopped and you feel comfortable and able to have sex.  We would recommend trying for a 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 will feel tired in the first few days following your operation.  Rest and recover and resume your normal activities when you feel ready to.  However, avoid heavy lifting, housework and strenuous exercise for 10-14 days.  Following this procedure you can normally return to work within 7-14 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 successes 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.

Feeling your baby move is a sign that they are well

Most women usually begin to feel their baby move between 16 and 24 weeks of pregnancy. A baby’s movements can be described as anything from a kick, flutter, swish or roll. The type of movement may change as your pregnancy progresses.

How often should my  baby move?

There is no set number of normal movements. Your baby will have their own pattern of movements that you should get to know. From 16-24 weeks on you should feel the baby move more and more up until 32 weeks then stay roughly the same until you give birth.  

It is NOT TRUE that babies move less towards the end of pregnancy.

You should CONTINUE to feel your baby move right up to the time you go into labour and whilst you are in labour too.

Get to know your baby’s normal pattern of movements.

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

If you think your baby’s movements have slowed down or stopped, contact your midwife or maternity unit immediately (it is staffed 24 hrs, 7 days a week).  
  • DO NOT put off calling until the next day to see what happens.
  •  Do not worry about phoning, it is important for your doctors and midwives to know if your baby’s movements have slowed down  or stopped.

Why are my baby’s  movements important? 

A reduction in a baby’s movements can sometimes be an important warning sign that a baby is unwell. Around half of women who had a stillbirth noticed their baby’s movements had slowed down or stopped.   Do not use any hand-held monitors, Dopplers or phone apps to check your baby’s heartbeat. Even if you detect a heartbeat, this does not mean your baby is well.

What if my baby’s movements are reduced again? 

If, after your check up, you are still not happy with your baby’s movement, you must contact either your midwife or maternity unit straight away, even if everything was normal last time.   NEVER HESITATE to contact your midwife or the maternity unit for advice, no matter how many times this happens.

Welcome to the Fertility Preservation Service at Prasad Hospital. 

Overview

As cancer treatments improve, the problems faced by survivors of cancer and the complications of cancer therapies become more important. 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. We therefore realise how important it is that all patients are able to discuss the effects of treatment with a fertility expert and explore whether they are able store eggs, sperm or embryos before their cancer treatment, which could be used to help them have their own biological child in the future.   Patients in this situation are faced with two devastating diagnoses simultaneously – cancer and infertility. Having to face both diagnoses can cause huge distress and therefore all patients will be offered an appointment to see one of our counsellors if they wish.

Our Service

Prasad Hospital has stored sperm for men facing cancer treatment for many years. Our Fertility Preservation service for female patients started in 2008. We appreciate that cancer treatment often has to start very quickly and if so we will see you within one week.   We offer NHS treatment to eligible patients and continue to work with health care purchasers to ensure that treatment is available to as many patients as possible.

The Effects of Cancer Treatment on Fertility

Following cancer treatment, most patients will be advised to delay conceiving for a period of 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 result in failure of the ovaries.  The risk of ovarian failure is higher with increased dose and duration of chemotherapy and with particular types of chemotherapeutic medication.  It is also more likely in women who already have reduced numbers of eggs, ie, older women.  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 is highly damaging to eggs and it is extremely rare for women to retain significant ovarian reserve after such treatment.  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 gynaecological malignancies can impact on a woman’s chance of pregnancy in the future.  Fertility options may therefore include the need for treatment with donated eggs or a surrogate host.  It is important that a woman’s desire for future pregnancies is always considered and that fertility sparing treatment is performed whenever possible. This is always discussed with the woman and the surgeon responsible for her cancer treatment.

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 has been shown to be the most effective way of freezing human eggs with more than 90% of vitrified eggs surviving after thawing. For women under the age of 35 years, approximately 1 in 3 cycles of egg freezing will result 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 a pregnancy following a cycle of egg freezing reduces as women age.   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% fertilise and form embryos. The laboratory will ring you the morning after egg collection to tell you how many eggs fertilised. The embryos are now at the ‘pronuclear’ one cell stage. It is at this stage that embryos will be vitrified for fertility preservation. In the UK embryos may be stored for up to 55 years.   Embryo freezing is a relatively successful procedure and follow-up studies on babies born are reassuring. Approximately 1 in 3 couples will conceive following embryo freezing if the woman is under 35 years of age. 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 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. Additionally women with hormone sensitive breast cancer will be asked to take letrozole tablets from day 4 of stimulation until 7 days after egg collection.   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 minimise any delay to oncology treatment. If you have any questions please ask.

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 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 indicating the stage of growth of the follicles and readiness for egg collection.
  • All blood tests are taken between 7.30 am and 8.30 am.

4. Ovulation trigger with Buserelin 

Buserelin is the last and final injection before egg collection is carried out. 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 (timing starts from 10.00 pm). This is the last injection you have prior to 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 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 possibly be arranged to commence from as soon as the day after egg collection.

What are the Risks of Fertility Preservation Treatment? 

Throughout treatment, we work closely with the team planning cancer treatment, to minimise any risk to you or delay to 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 as early as possible in their treatment pathway to give them the opportunity to consider fertility treatment if they wish without delay to their oncology treatment. In some cases, such as acute leukaemia, any delay to the start of chemotherapy may be significantly detrimental and these women are not able to freeze eggs or embryos, although male patients would usually have time to freeze a semen sample.

 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 an oestrogen sensitive breast cancer.  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 minimise any risk.

 Ovarian Hyperstimulation Syndrome (OHSS) 

OHSS is a complication seen in approximately 1% of women undergoing a cycle of ovarian stimulation for egg recovery.  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 Clinical Commissioning Group (GGC)/Trust Infertility/assisted conception guidelines.

Counselling 

Patients have found counselling 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 gives an indication 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 report to Ward 90 with your partner at 7.30 am on the date given to you over the telephone.   Please bring:
  •  Dressing gown
  •  Slippers
  •  Sanitary towels
  •  Something to read

Don’t forget! 

  •  Nothing to eat or drink from 12 midnight the night before your egg collection.
  •  If you are storing embryos your partner is to abstain from ejaculation for 2-4 days prior to the day of egg collection.
Number of eggs collected:

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

Possible side effects: 

  •  Local irritation at 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 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 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 needle from the packaging and remove the clear lid.
  3.  Pierce the grey bung and tip the vial upside down.
  4.  Pull down 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 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.  Put the remaining solution of Menopur in the cupboard for your next dose.

Storage Information 

Before reconstitution, store in a refrigerator (2°C - 8°C) in its original container to protect from light. After reconstitution, the solution may be stored for a maximum of 28 days at not more than 25°C. Do not freeze.

5. Bemfola 

What does it do? 

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

Possible side effects: 

  1.  Local irritation at injection site.
  2.  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.  Wash your hands and remove the peel tab from the injection needle.
  3.  Align the injection needle with the pen and gently push in. You will hear a click.
  4.  Remove the outer needle protection cap.
  5.  Remove the inner needle protection cap.
  6.  Hold the pen with the needle pointing upright. Tap the pen slightly in order 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 degrees angle.
  11.  Push the plunger until it stops.
  12.  Wait 5 seconds then remove the injection needle.
  13.   Dispose of the needle into the sharps bin provided.

Storage 

Store Bemfola in the refrigerator. Do not freeze. Store in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum for 28 days.

6. Gonal F

What does it do? 

Gonal F is an injection that contains 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 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 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 on 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 all the way 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 refrigerator.  Do not freeze. Store in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum for 28 days.

7. Cetrotide

What does it do?

Cetrotide blocks the effects of the natural hormone called gonadotropin-releasing hormone (GNRH). GNRH controls the secretion of another hormone called luteinising hormone (LH) which induces ovulation during the menstrual cycle.

Possible side effects: 

  •  Mood swings.
  •  Hot flushes.
  •  Headaches/nausea.
  •  Vaginal dryness.
  •  Local irritation at injection site.

How to use Cetrotide:

  1.  Remove from packaging.
  2.  Remove blue cap from vial of powder.
  3.  Take pre-filled syringe of water and remove the cap.
  4.  Attach the yellow needle (larger needle) on the end of pre-filled syringe of water.
  5.  Pierce the grey bung with the needle and push all of the water into vial.
  6.  Once all the powder has completely dissolved, draw up all solution back into the syringe.
  7.  Remove the large yellow needle and dispose in sharps bin provided.
  8.  Attach on 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 plunger down to administer Cetrotide.
  14.  Dispose of needle and syringe in to 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: 

  •  Headaches.
  •  Feeling restless or irritable.
  •  Depression.
  •  Breast tenderness or swelling.
  •  Local irritation at 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 off the vial.
  5.  Repeat with the other vial.
  6.  Remove syringe and green needle from packaging.
  7.  Twist green needle on the end of syringe.
  8.  Put the needle into water and pull the plunger to draw up all the water.
  9.  Remove the needle from the bottle and put needle into the vial of powder.
  10.  Push all the water into the vial.
  11.  Leave to dissolve for a few seconds then pull plunger back to draw up dissolved drug.
  12.  With the needle pointing upwards, flick the syringe so that any air bubbles move to the top.
  13.  Twist off green needle and dispose in sharps bin provided.
  14.  Twist on orange needle and push plunger up to remove any air.
  15.  Pinch an inch of fat below your belly button.
  16.  Inject at 45 degrees and push plunger down to give yourself full injection.
  17.  Remove needle and dispose in to sharps 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 works by acting on the pituitary gland in your brain to stop the production of natural hormones that control the release of eggs from your ovaries.

Possible side effects: 

  •  Mood swings.
  •  Hot flushes.
  •  Vaginal dryness.
  •  Headaches.
  •  Nausea.
  •  Local irritation at injection site.

How to use Buserelin: 

  1.  Remove Buserelin vial from the box.
  2.  Flick the blue cap off the lid (this does not need to be replaced afterwards).
  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.  Inject the needle 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

Buserelin needs to be stored in a refrigerator once opened.

10. Cabergoline 

Ovarian hyperstimulation syndrome (OHSS) is a complication resulting from administration of human chorionic gonadotrophin (hCG) in assisted reproduction technology (ART). Most cases are mild, but forms of moderate or severe OHSS appear in 3% to 8% of in vitro fertilisation (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 as instructed.

11. Metformin 

What does it do? 

Metformin is prescribed during IVF treatment for some people with Polycystic Ovary Syndrome (PCOS) or for 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.
This leaflet explains how you can help protect yourself and your children against flu this coming winter, and why it’s very important that people who are at increased risk from flu have their free flu vaccination every year.

What is flu? Isn’t it just a heavy cold? How will I know I’ve got it?

Flu occurs every year, usually in the winter, which is why it’s sometimes called seasonal flu. It’s a highly infectious disease with symptoms that come on very quickly. Colds are much less serious and usually start gradually with a stuffy or runny nose and a sore throat. A bad bout of flu can be much worse than a heavy cold. The most common symptoms of flu are fever, chills, headache, aches and pains in the joints and muscles, and extreme tiredness. Healthy individuals usually recover within two to seven days, but for some the disease can lead to hospitalisation, permanent disability or even death.

What causes flu?

Flu is caused by influenza viruses that infect the windpipe and lungs. And because it’s caused by viruses and not bacteria, antibiotics won’t treat it. If, however, there are complications from getting flu, antibiotics may be needed.

How do you catch flu and can I avoid it?

When an infected person coughs or sneezes, they spread the flu virus in tiny droplets of saliva over a wide area. These droplets can then be breathed in by other people or they can be picked up by touching surfaces where the droplets have landed. You can prevent the spread of the virus by covering your mouth and nose when you cough or sneeze, and you can wash your hands frequently or use hand gels to reduce the risk of picking up the virus. But the best way to avoid catching and spreading flu is by having the vaccination before the flu season starts.

How do we protect against flu?

Flu is unpredictable. The vaccine provides the best protection available against a virus that can cause severe illness. 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. During the last ten years the vaccine has generally been a good match for the circulating strains.

What harm can flu do?

People sometimes think a bad cold is flu, but having flu can be much worse than a cold and you may need to stay in bed for a few days. Some people are more susceptible to the effects of flu. For them, it can increase the risk of developing more serious illnesses such as bronchitis and pneumonia, or can make existing conditions worse. In the worst cases, flu can result in a stay in hospital, or even death. Flu vaccines help protect against the main three or four types of flu virus circulating

Am I at increased risk from the effects of flu?

Flu can affect anyone but if you have a long-term health condition the effects of flu can make it worse even if the condition is well managed and you normally feel well. You should have the free flu vaccine if you are: pregnant or have one of the following longterm conditions: • a heart problem • a chest complaint or breathing difficulties, including bronchitis, emphysema or severe asthma • a kidney disease • lowered immunity due to disease or treatment (such as steroid medication or cancer treatment) • liver disease • had a stroke or a transient ischaemic attack (TIA) • diabetes • a neurological condition, eg multiple sclerosis (MS), cerebral palsy or learning disability • a problem with your spleen, eg sickle cell disease, or you have had your spleen removed • are seriously overweight (BMI of 40 and above). By having the vaccination, paid and unpaid carers will reduce their chances of getting flu and spreading it to people who they care for. They can then continue to help those they look after. 

Who should consider having a flu vaccination?

All those who have any condition listed on this page, or who are: •  aged 65 years or over • living in a residential or nursing home •  the main carer of an older or disabled person •  a household contact of an immunocompromised person • a frontline health or social care worker • pregnant (see the next section) • children of a certain age.

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

Yes; the flu vaccine for each winter helps provide protection against the strains of flu that are likely to be present and may be different from last year’s. For this reason we strongly recommend that even if you were vaccinated last year, you should be vaccinated again this year. In addition protection from the flu vaccine may only last about six months so you should have the flu vaccine each flu season.

I think I’ve already had flu, do I need a vaccination?

Yes; other viruses can give you flulike symptoms, or you may have had flu but because there is more than one type of flu virus you should still have the vaccine even if you think you’ve had flu.

What about my children? Do they need the vaccination?

If you have a child over six months of age who has one of the conditions listed on page 4, they should have a flu vaccination. All these children are more likely to become severely ill if they catch flu, and it could make their existing condition worse. Talk to your GP about your child having the flu vaccination before the flu season starts. The flu vaccine does not work well in babies under six months of age so it is not recommended. This is why it is so important that pregnant women have the vaccination – they will pass on some immunity to their baby that will protect them during the early months of their life.

I am pregnant. Do I need a flu vaccination this year? 

Yes. All pregnant women should have the flu vaccine to help protect themselves and their babies. The flu vaccine can be given safely at any stage of pregnancy, from conception onwards. Pregnant women benefit from the flu vaccine because it helps: • reduce their risk of serious complications such as pneumonia, particularly in the later stages of pregnancy • reduce the risk of miscarriage or having a baby born too soon or with a low birth weight, which can be complications of flu • help protect their baby who will continue to have some immunity to flu during the first few months of its life • reduce the chance of the mother passing flu to her new baby

I am pregnant and I think I may have flu.  What should I do? 

If you have flu symptoms you should talk to your doctor urgently, because if you do have flu there is a prescribed medicine that might help (or reduce the risk of complications), but it needs to be taken as soon as possible after the symptoms appear. You can get the free flu vaccine from your GP, or it may also be available from your pharmacist or midwife. Some other groups of children are also being offered the flu vaccination. This is to help protect them against the disease and help reduce its spread both to other children, including their brothers or sisters, and, of course, their parents and grandparents. This will avoid the need to take time off work because of flu or to look after your children with flu. The children being offered the vaccine this year, are: • all two and three years of age ie born between 1 September 2013 and 31 August 2015 • all children in reception class and school years 1, 2, 3 and 4 ie born between 1 September 2008 and 31 August 2013 • all primary school aged children in some parts of the country (in former pilot areas) Children aged two and three years will be given the vaccination at their general practice usually by the practice nurse. All children in reception year and school years 1, 2, 3 and 4 throughout England will be offered the flu vaccine in school*. For most children, the vaccine will be given as a spray in each nostril. This is a very quick and painless procedure. Not all flu vaccines are suitable for children. Please make sure that you discuss this with your nurse, GP or pharmacist beforehand.

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

Yes. The flu vaccine can be given at the same time as all routine childhood vaccines. The vaccination can go ahead if your child has a minor illness such as a cold but may be delayed if your child has an illness that causes a fever.

Is there anyone who shouldn’t have the vaccination?

Almost everybody can have the vaccine, but you should not be vaccinated if you have ever had a serious allergy to the vaccine, or any of its ingredients. If you are allergic to eggs or have a condition that weakens your immune system, you may not be able to have certain types of flu vaccine – check with your GP. If you have a fever, the vaccination may be delayed until you are better.

What about my children? 

Children should not have the nasal vaccine if they: • are currently wheezy or have been wheezy in the past three days (vaccination should be delayed until at least three days after the wheezing has stopped) • are severely asthmatic, ie being treated with oral steroids or high dose inhaled steroids • have a condition, or are on treatment, that severely weakens their immune system or have someone in their household who needs isolation because they are severely immunosuppressed • have severe egg allergy. Most children with egg allergy can be safely immunised with nasal flu vaccine. However, children with a history of severe egg allergy with anaphylaxis should seek specialist advice. Please check with your GP • are allergic to any other components of the vaccine If your child is at high risk from flu due to one or more medical conditions or treatments and can’t have the nasal flu vaccine because of this, they should have the flu vaccine by injection. Also, children who have been vaccinated with the nasal spray should avoid close contact with people with very severely weakened immune systems for around two weeks following vaccination because there’s an extremely remote chance that the vaccine virus may be passed to them.

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

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

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

The nasal vaccine provides good protection against flu, particularly in young children. It also reduces the risk to, for example, a baby brother or sister who is too young to be vaccinated, as well as other family members (for example, grandparents) who may be more vulnerable to the complications of flu. The injected vaccine is not being offered to healthy children as part of this programme. However, if your child is at high risk from flu due to one or more medical conditions or treatments and can’t have the nasal flu vaccine they should have the flu vaccine by injection. Some faith groups accept the use of porcine gelatine in medical products – the decision is, of course, up to you. Don’t wait until there is a flu outbreak this winter, get your free flu jab now.

How long will I be protected for?

The vaccine should provide protection throughout the 2017/18 flu season.

Will the flu vaccine protect me completely?

Because the flu virus can change from year to year there is always a risk that the vaccine does not match the circulating virus. During the last ten years the vaccine has generally been a good match for the circulating strains.

Will I get any side effects?

Side effects of the nasal vaccine may commonly include a runny or blocked nose, headache, tiredness and some loss of appetite. Those having the injected vaccine may get a sore arm at the site of the injection, a low grade fever and aching muscles for a day or two after the vaccination. Serious side effects with either vaccine are uncommon.

Summary of those who are recommended to have the flu vaccine 

• everyone aged 65 and over • everyone under 65 years of age who has a medical condition listed on page 4, including children and babies over six months of age • all pregnant women, at any stage of pregnancy • all two- and three- year-old children • all children in reception class and school years 1, 2, 3 and 4 • all primary school-aged children in some parts of the country • everyone living in a residential or nursing home • everyone who is the main carer for an older or disabled person • household contacts of anyone who is immunocompromised • all frontline health and social care workers For advice and information about the flu vaccination, speak to your GP, practice nurse or pharmacist. It is best to have the flu vaccination in the autumn before any outbreaks of flu. Remember that you need it every year, so don’t assume you are protected because you had one last year.
Prior to starting fertility treatment you need to complete a number of 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 is to help us deliver a good and safe service to you and to comply with the law governing fertility treatment. This document describes the different consent forms and the issues to think about when completing them. In addition, our staff are 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 counselling service, which we encourage you to use, particularly if you are having 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. You do not have 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 team 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 own treatment.

1. Consent for treatment 

This form is similar to ones you complete before any medical or surgical treatment. It asks you to consent to any procedures required, such as egg collection and embryo transfer. Prior to completing this, you should have an understanding of the procedure involved, whether it is to be carried out under sedation or anaesthetic 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. However, we very strongly recommend that you give consent for us to be able to inform your GP as well as other medical practitioners who may be required to look after you for your continuing care, for instance in pregnancy. This is for your safety and to improve the quality of care you receive. Your general practitioner and any other doctor receiving information about your fertility treatment is obliged to maintain confidentiality about it, just as they would with any other information concerning your medical care. 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 Fertilisation 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 is also collected about any children born as a result of treatment. If you give consent, the HFEA can release some of this identifying information to researchers, for the purposes of 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. Being able to access identifying information may allow researchers to link records of fertility treatment with other healthcare records, which can be a powerful way of finding out whether there is a link between fertility treatment and important health outcomes. You can choose to give consent to your identifying information being used for certain types of research only. If you choose to consent for the purposes of 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

(MT form for men and WT form for women)

You can consent to the use of your gametes (eggs and sperm) and embryos for your own 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 storage of gametes and embryos, it is important to know that the statutory storage period is up to 10 years and can be specified on 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 of time 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. We will be in touch with you a few months before the end of the storage period to find out what you wish us to do. It is important that you keep in touch with us, in particular that you notify us of any change of address. If the storage time limit is up, and you have not consented to extending this, we are obliged by law to let any stored eggs, sperm or embryos perish, even if we have not been able to trace you first. 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 participating in any particular research, rather it allows us to provide you more information which you can use to make a decision 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 actually 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 counsellors are there to help you talk through any issues that may arise or to provide any clarification you may need.

4. Consent to parenthood

If you are having treatment with donor sperm, donor eggs or embryos created in vitro using donor sperm, you will be asked to complete the relevant consent forms before treatment takes place. This is to ensure that any child born has a legally recognised 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 individual 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. Finally, in some cases, it may be useful to seek independent legal advice regarding legal parenthood and how the law would apply to your specific case.

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 were 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 on a separate paper, signed, dated and attached to the form.

Violence, Aggression and Harassment Control Policy

We are committed to the well-being and safety of our patients and of our staff. Please treat other patients and staff with the courtesy and respect that you expect to receive. Verbal abuse, harassment and physical violence are unacceptable and will lead to prosecutions.  
Most people would benefit from improving their health, particularly couples who are trying to have a baby. A healthy lifestyle can improve your fertility and can also increase your chances of successful assisted conception 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 fertilised 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

  •  Some studies suggest that excessive caffeine can reduce your fertility – tea, coffee, cola and ‘energy’ drinks e.g. Red Bull are particularly high in caffeine – try caffeine free alternatives or drink water or squash.
  •  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? 

  •  It helps you to achieve and maintain a healthy 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.
  • Aim for at least five portions of fruit and vegetables a day.
  • If you are trying to lose weight fruit makes an excellent snack or dessert.
  • Choose fresh, frozen or tinned (avoid fruit tinned in syrup).

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 tablespoonfuls 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, wholemeal 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 as much calcium as the regular versions.

 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 eg, 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 the ‘Eating for Pregnancy’ Helpline on: (0114) 242 4084.

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.
In addition, illness associated with fever temporarily reduces fertility. 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 Unit staff.

Cope with stress 

We know from couples undergoing infertility treatment that their experience can be an extremely stressful one. This is understandable, especially if a couple believe that their future happiness depends upon a successful treatment outcome. Stress in such a situation is unavoidable. However, it is not stress itself that causes problems but the way in which an individual responds 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.
Staff at the unit want to help couples avoid the distress such symptoms bring about. For this reason we recommend that you give some thought now as to the coping mechanisms you currently employ to deal with stress. Are they positive and likely to get you through treatment in good shape? Or, are they negative and therefore likely to make the situation worse? Here are some ways of coping positively with stress that some couples have found helpful:
  •  Yoga.
  • Physical exercise – swimming, running etc.
  • Learning how to relax – using tapes, books, videos.
  • Stress management courses – night school, information from GPs, libraries etc.
  • Support – building your own network using friends, family, counsellors
Counselling is available at the Reproductive Medicine Unit, whilst you are on the waiting list also during and after treatment, should you require it. For further information or to arrange an appointment please contact the counselling service via our reception: (0161) 276 6494, Monday – Friday, 9.00 am – 1.00 pm. We want you to feel able to give treatment its best chance of success. Using positive coping mechanisms to deal with stress may help you to do it. The information provided in this leaflet is not intended to replace verbal communication with medical or nursing staff.

What is ICSI and why is it necessary?

Intra-cytoplasmic sperm injection (ICSI) refers to the technique of injecting a single sperm into the centre (cytoplasm) of the egg.  In natural conception a large number of sperm surround the egg and many attach to the outside, but only one sperm penetrates and fertilises each egg.  In standard IVF we mimic nature by adding a large number of sperm to the dish containing the egg.  In ICSI the scientist selects sperm based on their activity and appearance.  A single sperm is then injected into each mature egg using specialised equipment that allows the egg and sperm to be handled precisely.

Which couples require ICSI?

ICSI is recommended in cases where there is a clear sperm problem, as otherwise there is a risk that the eggs may fail to fertilise. If a sperm problem is known of beforehand, we will usually advise that you undergo ICSI. If you are using surgically retrieved sperm, we will usually advise ICSI. If there is no known sperm problem we advise standard IVF, as ICSI gives no benefit to such couples. However, sometimes on the day of egg collection the sperm sample is unexpectedly poor. If this happens, we will carry out ICSI to try to achieve fertilisation. We may also recommend ICSI if you have had standard IVF and there was a very low fertilisation rate, or no fertilisation. This can happen occasionally, even if there is no obvious 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?

Except for the method of fertilisation, every other aspect of your treatment cycle is identical for ICSI and conventional IVF, including hormonal stimulation, egg recovery, producing the sperm sample and embryo replacement. On the day of ICSI, the embryologist carefully removes the outer (cumulus) cells from each egg, using an enzyme normally produced by sperm. This enables the embryologist to see inside the egg using a high powered microscope and assess if the egg is ‘mature’. All eggs can be inseminated by IVF, but only mature eggs can be used in ICSI.  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 (see diagram below).

 How successful is ICSI? 

Approximately 6 out of every 10 eggs will fertilise successfully by ICSI, similar to IVF. The reasons for ICSI fertilisation not being 100% successful include:
  • Immature eggs cannot be injected.
  • Some eggs may be damaged by the injection procedure. This appears to be related to the properties of the inner egg membrane.
  • Even when injected directly into the egg, many sperm are not capable of ‘activating’ the egg.
Following successful fertilisation, embryo development is similar for ICSI and IVF. Following embryo transfer, pregnancy rates are similar to IVF.

What risks are associated with ICSI treatment? 

ICSI offers the opportunity of success for couples who could not achieve it otherwise. However, it does carry some additional 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. As ICSI bypasses the normal processes of sperm ‘selection’ and fertilisation, these genetic defects may be transmitted to the children. It is also possible that the egg may be damaged by the injection procedure. Theoretically, this can result in damage to the resulting embryo if the damaged egg is fertilised normally. In 2005, a major European review of children born after ICSI and IVF (followed up until 5 years of age) found that so-called major birth defects involving the heart, lungs, musculoskeletal or gastrointestinal systems, were present in about 2% of naturally conceived offspring, 4% of children conceived by routine IVF, and in 6% of children conceived after ICSI. A substantial proportion of the abnormalities in the ICSI children were problems in the development of the urinary or genital organs, especially in boys. However, all of them were correctable by surgery and they were found to be caused by genetic factors from the father, rather than a result of the ICSI procedure itself. Minor birth defects were present in about 20% of naturally conceived offspring, 31% of children conceived by routine IVF, and in 29% of children conceived after ICSI. Minor anomalies are those which do not in themselves have serious medical, functional or cosmetic consequences for the child. More recent studies reported no difference in the risk for any anomaly or specific anomalies after different types of IVF technologies including ICSI. It should be borne in mind that the great majority of babies born by ICSI do not display any abnormalities  

 

What is Induction of Ovulation (IOO)?

Induction of ovulation (IOO) involves stimulating the ovaries to produce one or two follicles which, hopefully, will contain an egg each. The process is used in one of two ways:

• Natural intercourse

The release of the eggs is timed to coincide with either regular intercourse, thereby giving couples an opportunity to achieve a pregnancy. This method is suitable for couples with ovulatory disorders

Stimulated intra-uterine insemination (S-IUI)

Alternatively the ovulation can be timed to coincide with injection of prepared sperm into the woman’s uterus. This method is suitable for couples with unexplained infertility, endometriosis and mild sperm abnormalities.

What is involved in the treatment?

You will need to ring the nurses on (0161) 276 6209 between 8.00 am and 11.00 am) on the first day of your period  (the day you wake up bleeding) to request treatment. You will be asked to attend the Unit for a blood test and a  scan on Day 2 or Day 3 of your cycle. Based on the results of these tests you will be asked to start daily injections of gonadatrophins to stimulate the ovaries.  The nurses will teach you how to self-administer these and  give you a supply to keep at home. You will then come back to the Unit on Day 8 of your cycle for another blood test and transvaginal scan so that the development of the follicles can be monitored. You will continue with your injections and attend the Unit on days determined by the Unit until mature follicles are confirmed on the scan. This means having one or two follicles measuring around 16mm or above. The nurses will then ask you to take an injection of hCG (Pregnyl) to stimulate ovulation. If you are having IOO, we recommend you have intercourse every other day around this period. If you are having IUI, you will be requested to attend the Unit with your partner the next morning. He will be asked to provide a semen sample which will be prepared in the laboratory for insemination. A few hours later that same day, you will have the IUI. The procedure is relatively painless and similar to a smear test. It will take around 15 minutes and you can carry on with your usual activities afterwards.

What are the risks?

The drugs used for this treatment are given in low doses and so are relatively safe. There is a small risk of developing ovarian hyperstimulation syndrome (OHSS) because of which you will be regularly monitored through blood tests and scans to prevent  this complication. If you develop significant nausea, vomiting, shortness of breath or have severe abdominal pain, you must contact the nurses as soon as possible on (0161) 276 6209 (between 7.30 am and 4.00 pm for emergencies). Out of hours you can call the Emergency Gynaecology Unit on (0161) 276 6204. If more than 3 dominant follicles develop during treatment, the cycle might be cancelled because of the risk of multiple pregnancies. You would not be given Pregnyl and would be  asked to have only protected intercourse (using condoms).  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. Please note: The Unit can only accept a finite number of requests for treatment each month, therefore it may not be possible to accept you in the month you ring to request treatment.  
Sperm storage is provided as back up for your infertility treatment at Saint Mary’s Hospital. Wherever possible, a fresh semen sample would be used on  the day of your infertility treatment.

How are the samples produced and stored?

Semen samples are produced here in Andrology, in a private room, by masturbation. Samples are stored in small, sealed bottles in liquid Nitrogen vapour. These bottles are carefully labelled with your name, date of birth and reference number, and are witnessed by a second member of staff, who also verifies the 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 telephone Andrology the next working day, before 3.00 pm, on (0161) 276 6473, to confirm if your sample was frozen and has been assessed for suitability as back up for infertility treatment.

How long can sperm be stored?

By law, sperm can be stored up to 10 years or until your infertility treatment at Saint Mary’s is completed, whichever  is soonest. The sample(s) will then be destroyed unless you  make alternative arrangements. 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?

Whilst we do everything possible to ensure the safety of your samples, we cannot guarantee against all 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 I don’t have any sperm stored?

If you are unsuccessful in storing any sperm or if the sperm sample fails the freezing and defrosting process then you will be referred back to your doctor. You will be seen in the clinic where your doctor will discuss alternative options.

When can we use the sperm?

Once the sperm freezing procedure is complete, your doctor at Saint Mary’s Hospital is notified. 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 back up for infertility treatment. A fresh semen sample is preferable for infertility treatment and you will be expected to produce a fresh semen sample on the day of infertility treatment.

How successful are these treatments?

Each treatment method has a different success rate, and a lot will depend on the potential fertility of your wife/partner. Frozen sperm, however, is not as fertile as fresh sperm and we are unable to guarantee that a pregnancy will result from its use. 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 success of using samples depends on the quality and quantity of the sperm which was stored. Men who have been very ill systemically, for example, with persistent fever, weight loss, loss of appetite etc, generally have very poor sperm samples and sometimes may have even ‘switched off’ their sperm production completely. Therefore the quality of sperm samples obtained is variable between patients and depends on individual circumstances. Cancers that affect the whole body, such as leukaemia, may have a more profound effect when compared to localised tumours with a malignant potential. We will always offer you the chance rather than make judgements ourselves. The samples are diluted with a preservative when they are frozen to protect the sperm against damage during the freezing process. However this does not guarantee the sample will survive the freeze-thaw process, and even if it does, there is usually a reduction in the motility (movement) of the sperm. As previously stated the chances of success in achieving a pregnancy depend on many factors including the method chosen for their use. If sufficient numbers of sperm of adequate quality have been frozen then we would expect you to have a reasonable chance of achieving a pregnancy, but this cannot be guaranteed.

Counselling

Infertility counselling is available at Saint Mary’s Hospital and appointments to see the counsellor can be arranged for you.

How to find us

The Andrology laboratories are based in the Department of Reproductive Medicine in the Old Saint Mary’s Hospital (Oxford Road) on the first floor. Turn right at the top of the stairs and then right again. Please come into reception and ring the bell for attention. If you are a wheelchair user please telephone the department in advance on (0161) 276 6473 so we can arrange to meet you at the disabled access to the left of the building.

Car Parking

A multi-storey car park is located next to Saint Mary’s Hospital at the junction of Upper Brook Street and Hathersage Road. The entrance to the car park is on Hathersage Road. For car parking tariffs see http://www.cmft.nhs.uk , go to ‘Show Information for Patients, Visitors and Carers Links’ and click ‘Getting to Hospital’. Parking is provided free on the ground floor for patients with mobility problems who are displaying the appropriate badge. Vehicles will be clamped if they are parked inappropriately.

Violence, Aggression and Harassment Control Policy

We are committed to the well-being and safety of our patients and of our staff. Please treat other patients and staff with the courtesy and respect that you expect to receive. Verbal abuse, harassment and physical violence are unacceptable and will lead to prosecutions.

Suggestions, Concerns and Complaints

If you would like to provide feedback you can: • Ask to speak to the ward or department manager. •  Write to us: Prasad Hospital, Adj. BSNL Telephone Exchange, Nacharam – Mallapur Road, Secunderabd – 76 •  Log onto the NHS Choices website www.nhs.uk - click on ‘Comments’. If you would like to discuss a concern or make a complaint: •  Ask to speak to the ward or department manager – they may be able to help straight away. •  Contact Us  Tel: +91-40-33050555  e-mail: info@prasadhospitals.in  for  our information leaflet. We welcome your feedback so we can continue to improve our services.

1. Overview

The first injection that you will administer is called Buserelin. Buserelin is used to temporarily suppress your hormones before ovarian stimulation begins. Your Buserelin injections will start during the luteal phase of your menstrual cycle (approximately day 21) and will continue daily until you have been advised that you are ready for your egg collection. You should administer the injections at the same time every day between 7.00 am–10.00 am. After approximately 2 weeks of Buserelin you will attend the unit for a blood test to check that your oestrogen and luteinising hormone are low. If your blood test result is satisfactory, you will be advised to start a daily stimulation injection. There are different types of stimulation drugs some common ones used are Gonal F, Bemfola and Menopur. They are all similar in their effects. Your stimulation injection usually begins within a few days of this blood test. The stimulation injections encourage the development of several follicles within each ovary. Response does vary but is mostly dependent upon the number of small follicles that the woman has in her ovaries at the start of each menstrual cycle. These small follicles are counted on a baseline ultrasound scan before starting treatment as this is a good predictor of the number of mature follicles that we will be able to stimulate. You will take your stimulation injection alongside your Buserelin injection. Once you have started the stimulation injection, you will be monitored by regular blood tests and scans. Blood is taken to check your oestrogen level. This gives an indication as to how your ovaries are responding to the stimulation drug. Monitoring usually starts on day 8 of stimulation and will be clearly marked on your injection chart. You will be required to attend every 2-3 days for a blood test and internal scan to assess how your follicles are growing. This monitoring will continue until 3 or more follicles are at the optimum size of 17-20mm. The doctor will decide when this is. Blood tests are taken between 7.45 am and 8.30 am in the morning to ensure that we get the results back by lunchtime. Scans are carried out from 8.30 am and you will be given the earliest available appointment. Once your blood and/or scan results have been reviewed, you may be required to alter the dose of your stimulation drug. If an alteration is required, you will receive a phone call in the afternoon from one of the nurses who will inform you of your new dose. If you do not receive a telephone call to alter your dose, please continue taking your stimulation drug at the same dose. It is important that you are contactable throughout the whole of your treatment. Please provide alternative contact numbers where required. Usually, it takes 10-14 days of stimulation until you are ready to take your final injection in preparation for your egg collection. As everybody responds differently, you may find that you are ready earlier or later than this. On the day that your follicles are at the optimum size, you will be asked to administer your final injection that night. The final injection is called Pregnyl and helps to mature your eggs in preparation for collection. Pregnyl must be taken at the specific time given to you, which will be approximately 35-36 hours prior to your egg collection. It is important that your take this injection at the time provided. If you miss this time slot please DO NOT take it at any other time. Contact the Department the following day and where possible this will be re-arranged. Please note that missing your final injection or taking it at the wrong time could result in failure or cancellation of your treatment. You must fast from 12 midnight the night before your egg collection. This means no food or drink, including chewing gum. On the day of your egg collection you will be required to report to Ward 90, which is located on the first floor of the Old Saint Mary’s building, with your partner at 7.30 am. On this day your partner will be required to provide a semen sample, unless frozen or donor sperm is being used. Prior to providing this sample, 2-5 days of abstinence from intercourse or ejaculation is required. Following the egg collection and before you are discharged from the ward you will be informed how many eggs were collected. The day after your egg collection, a member of the embryology team will contact you to inform you if and how many of your eggs fertilised. They will also inform you when to come back to the unit for embryo replacement, which will usually take place 2, 3 or 5 days after the egg collection. If your eggs fertilise successfully and you are having a fresh embryo transfer, you will be required to start a form of luteal support (progesterone) the morning after egg collection. The nurse will instruct you how to take this. If you have any questions or concerns throughout treatment, please ring the nurses on (0161) 276 6209. You may be required to leave a message but all calls will be returned.

2. Buserelin Chart 

If you have not started a period by the day before you are due for this blood test, please contact the unit on (0161) 276 6209. Please choose a convenient time between 7.00 am and 10.00 am to take your injections. You must stick to this time throughout your treatment.

3. Stimulation drug chart

Please attend for all blood tests between 7.45 am and 8.30 am. The nurse will inform you of when you need to attend for your blood tests. Please write down the date in your chart above. You will be booked for scans on alternate days from day 8 of stimulation. Scan times will be confirmed once stimulation has been started. 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.

4. Your final 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. Pregnyl 5000 IU 10,000 IU Injection to be given at: _____:_____ hours / __________ am/pm On: Day ______________ Date _______________  Please report to Ward 90 with your partner at 7.30 am on the date given to you over the telephone.  Please bring:
  • Slippers
  • Dressing gown
  • Sanitary towels
  • Something to read

Don’t forget! 

  • Nothing to eat or drink from 12 midnight the night before your egg collection.
  • Partner to abstain from ejaculation for 2-5 days if providing a semen sample on the day of egg collection.
  • Leave valuables at home.
  • Do not wear make-up or jewellery.

5. Buserelin 

What does it do? 

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

Possible side effects: 

  •  Mood swings.
  • Hot flushes.
  • Vaginal dryness.
  • Headaches.
  • Nausea.
  • Local irritation at injection site.

How to use Buserelin:

1) Remove Buserelin vial from the box. 2) Flick the blue cap off the lid (this does not need to be replaced afterwards). 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) Inject the needle 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 

Buserelin needs to be stored in a refrigerator once opened

6. Menopur  

 What does it do?

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

Possible side effects:

  •  Local irritation at 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).
If you experience any of these symptoms, you must inform a nurse at the unit as soon as possible.  If the unit is closed, please telephone the Gynaecology ward (Ward 62) in the main hospital) on (0161) 276 6518 or (0161) 276 6410.

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 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 needle from the packaging and remove the clear lid. 3) Pierce the grey bung and tip the vial upside down. 4) Pull down 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 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) Put the remaining solution of Menopur in the cupboard for your next dose.

Storage Information 

Before reconstitution, store in a refrigerator (2°C - 8°C) in its original container to protect from light. After reconstitution, the solution may be stored for a maximum of 28 days at not more than 25°C. Do not freeze.

7. Gonal F

What does it do? 

Gonal F is an injection that contains 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 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).
If you experience any of these symptoms, you must inform a nurse at the unit as soon as possible.  If the unit is closed, please telephone the Gynaecology ward (Ward 62 in the main hospital) on (0161) 276 6518 or (0161) 276 6410.

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 on 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 all the way 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 refrigerator. Do not freeze. Store in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum for 28 days.

8. Pregnyl 

 What does it do?

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

Possible side effects: 

  •  Headaches.
  • Feeling restless or irritable.
  • Depression.
  • Breast tenderness or swelling.
  • Local irritation at injection site.
  • Exacerbation of OHSS symptoms.

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 off the vial. 5) Repeat with the other vial. 6) Remove syringe and green needle from packaging. 7) Twist green needle on the end of syringe. 8) Put the needle into water and pull the plunger to draw up all the water. 9) Remove the needle from the bottle and put needle into the vial of powder. 10) Push all the water into the vial. 11) Leave to dissolve for a few seconds then pull plunger back to draw up dissolved drug. 12) With the needle pointing upwards, flick the syringe so that any air bubbles move to the top. 13) Twist off green needle and dispose in sharps bin provided. 14) Twist on orange needle and push plunger up to remove any air. 15) Pinch an inch of fat below your belly button. 16) Inject at 45 degrees and push plunger down to give yourself full injection. 17) Remove needle and dispose in to sharps bin.

Storage Information

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

9. Progesterone (luteal support) 

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

What does it do?

Progesterone is a natural female hormone, produced in the body. It used in IVF treatment to help support the endometrium (lining of the womb) and a possible early pregnancy.

Possible side effects: 

  • Diarrhoea.
  • Flatulence (wind).
  • Soreness in your vagina or rectum.
  • Headaches.
After using progesterone you may notice some leakage after the pessary has dissolved. Do not worry; this is quite normal when using medicines that are inserted into the vagina or rectum.

How to use 

Always wash your hands before and after inserting the pessary. To insert into the: Vagina – place the pessary between the lips of the vagina and gently push the pessary upwards and backwards using your finger. Or applicator if one is available. Insert as far as it feels comfortable. Rectum – gently push the pessary into the rectum foe about one inch. Your muscles will hold the pessary in place when it is in far enough. Squeeze your buttocks together for a few seconds. This route can only be used with cyclogest pessaries.

Storage 

Store below 25 degrees centigrade in a dry place.

10. Bemfola 

What does it do?

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

Possible side effects:

1. Local irritation at injection site. 2. 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).
If you experience any of these symptoms, you must inform a nurse at the unit as soon as possible. If the unit is closed, please telephone the Gynaecology ward (Ward 62) in the main hospital) on (0161) 276 6518 or (0161) 276 6410

How to use bemfola:

1. Take the syringe and needle out of the box. 2. Wash your hands and remove the peel tab from the injection needle. 3. Align the injection needle with the pen and gently push in. You will hear a click. 4. Remove the outer needle protection cap 5. Remove the inner needle protection cap. 6. Hold the pen with the needle pointing upright. Tap the pen slightly in order 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 degrees angle. 11. Push the plunger until it stops. 12. Wait 5 seconds then remove the injection needle. 13.  Dispose of the needle into the sharps bin provided.

Storage

Store Bemfola in the refrigerator. Do not freeze. Store in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum for 28 days.

Sedation in IVF: Information for Patients having Egg Recovery

During the process of egg recovery the surgeon will place a scanning probe into the vagina in a very similar way to your previous scans. A fine needle is then inserted alongside the probe. When the needle is used to suck out the ripened eggs a momentary discomfort often occurs - once for each ovary. To help with this it is routine practice to use intravenous sedation and a short acting and very powerful pain relieving medication together rather than general anaesthetic. You will therefore be sedated and not fully unconscious. This is very safe. You may have had a general anaesthetic in the past and feel you will not cope with sedation. Whilst there are some surgical reasons for general anaesthetic, these are rare and your surgeon will advise you if this is necessary. The vast majority of patients in the UK and throughout the world have sedation to enable egg recovery and are very satisfied with it. Sedation is recommended and preferred as the method for this procedure by the National Institute for Health and Clinical Excellence (NICE) and is our technique of choice in this unit. In a recent survey, well over 95% of patients were very happy with their experience and would have sedation again if it was needed. They also benefitted from low rates of nausea and vomiting and a shorter recovery and stay in hospital - often leaving by lunchtime. During the procedure you will be fully monitored, which is routine. The surgeon will reassure you if necessary during the egg recovery procedure, but it is best to relax with the sedation and allow the surgeon to proceed. Although the majority of our sedated patients do not remember any detail of the procedure itself or any discomfort, it is important that you understand that with sedation there is a possibility that you may remember some events during surgery and that you may feel the probe and possibly a little discomfort. Only with general anaesthetic would you be completely unaware. We would strongly recommend that sedation is our preferred method for egg recovery. After a short period of recovery and a bite to eat and a drink the ward nurses will ensure that you are safe to leave us. Typically the whole process takes about 30 minutes, however if you do require a general anaesthesia you would take longer to recover and may have to stay in hospital longer; this is because the dose of anaesthetic is larger and is often different. Please remember that you should not operate any machine, drive or sign important documents until the day after as your judgement may be impaired. This applies to both sedation and anaesthetic. Please ask the fertility nurses if you have any questions about what will happen to you.

1. Overview

1. Please call the unit on (0161) 276 6209 on the first day of your next period (the day you wake up bleeding). 2. Inform the unit that you are on the short protocol, you have all your medication at home and that you have attended your teach appointment. 3. If we are able to accept you for treatment, we will give you instructions on when to start your injections 4. In some circumstances we may ask you to attend for a blood test and ultra sound scan on day 2 or 3. In this case, we will telephone you in the afternoon with further instructions. 5. You will be given a date to start your daily stimulation injection. There are different types of stimulation drugs some common ones used are Gonal F, Bemfola and Menopur. They are all similar in their effects. The stimulation injections encourage development of several follicles in your ovaries, each of which contains an egg. The response of your ovaries to stimulation depends on your ovarian reserve and this will have been discussed with you at your initial IVF appointment. 6. On the 5th day of stimulation injections you will commence an additional injection called Cetrotide, which suppresses your luteinising hormone (LH) surge, to prevent ovulation. You will take your Cetrotide alongside your stimulation injection. Please continue both of these injections until you are advised to stop. 7. If you have been prescribed Metformin tablets following your consultation, please continue to take these until the day of egg collection. 8. Once you have started your injections, you will be monitored by regular blood tests and scans. These tests give us an indication of how your ovaries are responding to stimulation. 9. Your first monitoring blood test and scan will be on day 6 of stimulation and we will advise you of this date and time. Depending on the result of this we may ask you to return every 2 or 3 days until your tests show that you are ready for egg collection. 10. Blood tests are taken between 7.45 am and 8.30 am in the morning to ensure that we get the results back by lunchtime. Scans are carried out from 8.30 am and you will be given the earliest available appointment. 11. Once your blood and/or scan results have been reviewed, you may be required to alter the dose of your stimulation drug. If an alteration is required, you will receive a telephone call in the afternoon from one of the nurses who will inform you of your new dose. Please ensure that you are able to take a call or have a voicemail service on your telephone. If you do not receive a telephone call to alter your dose, please continue taking your stimulation drug at the same dose. It is important that you are contactable throughout the whole of your treatment. Please provide alternative contact numbers where required. Usually, it takes 10-14 days of stimulation until you are ready to take your final injection in preparation for your egg collection. As everybody responds differently you may find that you are ready earlier or later than this. 12. On the day that your follicles are at the optimum size, you will be asked to administer your final injection that night. The final injection is the 'trigger' for your egg collection and you may be asked to take either Pregnyl or Buserelin for this. It is important that your take this injection at the time provided. If you miss this time slot please do not take it at any other time. Contact the Department the following day and where possible this will be re-arranged. Please note that missing your final injection or taking it at the wrong time could result in failure or cancellation of your treatment. 13. You must fast from 12 midnight the night before your egg collection. This means no food or drink, including chewing gum or sweets. On the day of your egg collection you will be required to report to Ward 90, which is located on the first floor of the Old Saint Mary’s building, with your partner at 7.30 am. 14. On this day your partner will be required to provide a semen sample, unless frozen or donor sperm is being used. Prior to providing this sample, 2-5 days of abstinence from intercourse or ejaculation is required. 15. Following the egg collection, before you are discharged from the ward you will be informed of how many eggs were collected. 16. The day after your egg collection, the embryologists will contact you to inform you if and how many of your eggs fertilised. They will also inform you when to come back to the unit for embryo replacement, which will usually take place 2, 3 or 5 days after the egg collection. 17. If your eggs fertilise successfully and you are having a fresh embryo transfer, you will be required to start a form of luteal support (progesterone) the morning after egg collection. The nurse will instruct you how to take this. If you have any questions or concerns throughout treatment please ring the nurses on (0161) 276 6209. You may be required to leave a message but all calls will be returned.

2. Drug Chart 

Please attend for ALL blood tests between 7.45 am and 8.30am. The nurse will inform you of when you need to attend for your blood tests and scans. Please write down the date in your chart above. Scan times will be confirmed once stimulation has been started. 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. Please choose a convenient time between 7.00 am-10.00 am to take your injections. You must stick to this time throughout your treatment.

3. Your final injection

You are now ready to take your trigger injection. The nurse will inform you whether this is to be Pregnyl or Buserelin. Pregnyl 5000 IU OR Buserelin 2mg Injection to be given at: _____:_____ hours / __________ am/pm On: Day ______________ Date _______________ Please report to Ward 90 with your partner at 7.30 am on the date given to you over the telephone. Please bring:
  • Dressing gown
  • Slippers
  • Sanitary towels
  • Something to read

Don’t forget! 

  • Nothing to eat or drink from 12 midnight the night before your egg collection.
  • Partner to abstain from ejaculation for 2-5 days if providing a semen sample on the day of egg collection.
  • Leave valuables at home.
  • Do not wear make-up or jewellery.

4. Menopur  

What does it do?

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

Possible side effects:

  • Local irritation at 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).
If you experience any of these symptoms, you must inform a nurse at the unit as soon as possible.  If the unit is closed, please telephone the Gynaecology ward (Ward 62) in the main hospital) on (0161) 276 6518 or (0161) 276 6410.

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 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 needle from the packaging and remove the clear lid. 3) Pierce the grey bung and tip the vial upside down. 4) Pull down 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 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) Put the remaining solution of Menopur in the cupboard for your next dose.

Storage Information 

Before reconstitution, store in a refrigerator (2°C-8°C) in its original container to protect from light. After reconstitution, the solution may be stored for a maximum of 28 days at not more than 25°C. Do not freeze.

5. Gonal F  

What does it do?

Gonal F is an injection that contains 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 injection site
  • Ovarian Hyperstimulation Syndrome (OHSS)
Signs/symptoms to look out for include:
  • swelling/pain.
  • Shortness of breath.
  • Extreme thirst.
  • Nausea/vomiting.
  • Headaches.
  • Problems passing urine (small amounts or none at all).
If you experience any of these symptoms, you must inform a nurse at the unit as soon as possible.  If the unit is closed, please telephone the Gynaecology ward (Ward 62 in the main hospital) on (0161) 276 6518 or (0161) 276 6410.

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 on 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 all the way 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 refrigerator. Do not freeze. Store in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum for 28 days.

6. Cetrotide  

What does it do?

Cetrotide blocks the effects of the natural hormone called gonadotropin-releasing hormone (GNRH).  GNRH controls the secretion of another hormone called luteinising hormone (LH) which induces ovulation during the menstrual cycle.

Possible side effects: 

  • Mood swings.
  • Hot flushes.
  • Headaches/nausea.
  • Vaginal dryness.
  • Local irritation at injection site

How to use Cetrotide:

1) Remove from packaging. 2 ) Remove blue cap from vial of powder. 3) Take pre-filled syringe of water and remove the cap. 4) Attach the yellow needle (larger needle) on the end of pre-filled syringe of water. 5) Pierce the grey bung with the needle and push all of the water into vial. 6) Once all the powder has completely dissolved, draw up all solution back into the syringe. 7) Remove the large yellow needle and dispose in sharps bin provided. 8) Attach on 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 plunger down to administer Cetrotide 14) Dispose of needle and syringe in to sharps bin.

Storage information:

Keep in the box in a dry cool place

7. Pregnyl 

What does it do?

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

Possible side effects:

  • Headaches.
  • Feeling restless or irritable.
  • Depression.
  • Breast tenderness or swelling.
  • Local irritation at injection site.
  • Exacerbation of OHSS symptoms.

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 off the vial. 5) Repeat with the other vial. 6) Remove syringe and green needle from packaging. 7) Twist green needle on the end of syringe. 8) Put the needle into water and pull the plunger to draw up all the water 9) Remove the needle from the bottle and put needle into the vial of powder. 10) Push all the water into the vial. 11) Leave to dissolve for a few seconds then pull plunger back to draw up dissolved drug. 12) With the needle pointing upwards, flick the syringe so that any air bubbles move to the top. 13) Twist off green needle and dispose in sharps bin provided. 14) Twist on orange needle and push plunger up to remove any air. 15) Pinch an inch of fat below your belly button. 16) Inject at 45 degrees and push plunger down to give yourself full injection. 17) Remove needle and dispose in to sharps bin.

Storage Information

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

8. Metformin 

What does it do?

Metformin is prescribed during IVF treatment for some people with Polycystic Ovary Syndrome (PCOS) or for 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.

9. Progesterone (luteal support) 

This is often given in the form of a vaginal or rectal suppository

What does it do?

Progesterone is a natural female hormone, produced in the body. It used in IVF treatment to help support the endometrium (lining of the womb) and a possible early pregnancy.

Possible side effects: 

  • Diarrhoea.
  • Flatulence (wind).
  • Soreness in your vagina or rectum.
  • Headaches
After using progesterone you may notice some leakage after the pessary has dissolved. Do not worry; this is quite normal when using medicines that are inserted into the vagina or rectum.

How to use

Always wash your hands before and after inserting the pessary. To insert into the: Vagina – place the pessary between the lips of the vagina and gently push the pessary upwards and backwards using your finger. Or applicator if one is available. Insert as far as it feels comfortable. Rectum – gently push the pessary into the rectum foe about one inch. Your muscles will hold the pessary in place when it is in far enough. Squeeze your buttocks together for a few seconds. This route can only be used with cyclogest pessaries.

Storage

Store below 25 degrees centigrade in a dry place.

10. Bemfola

 What does it do?

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

Possible side effects:

1. Local irritation at injection site. 2. 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)
If you experience any of these symptoms, you must inform a nurse at the unit as soon as possible. If the unit is closed, please telephone the Gynaecology ward (Ward 62) in the main hospital) on (0161) 276 6518 or (0161) 276 6410.

How to use bemfola:

1. Take the syringe and needle out of the box. 2. Wash your hands and remove the peel tab from the injection needle. 3. Align the injection needle with the pen and gently push in. You will hear a click. 4. Remove the outer needle protection cap 5. Remove the inner needle protection cap. 6. Hold the pen with the needle pointing upright. Tap the pen slightly in order 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 degrees angle. 11. Push the plunger until it stops. 12. Wait 5 seconds then remove the injection needle. 13.  Dispose of the needle into the sharps bin provided.

Storage

Store Bemfola in the refrigerator. Do not freeze. Store in the original packaging to protect from light. Once opened, it may be stored at or below 25°C for a maximum for 28 days.

Sedation in IVF: Information for Patients having Egg Recovery 

During the process of egg recovery the surgeon will place a scanning probe into the vagina in a very similar way to your previous scans. A fine needle is then inserted alongside the probe. When the needle is used to suck out the ripened eggs a momentary discomfort often occurs - once for each ovary. To help with this it is routine practice to use intravenous sedation and a short acting and very powerful pain relieving medication together rather than general anaesthetic. You will therefore be sedated and not fully unconscious. This is very safe. You may have had a general anaesthetic in the past and feel you will not cope with sedation. Whilst there are some surgical reasons for general anaesthetic, these are rare and your surgeon will advise you if this is necessary. The vast majority of patients in the UK and throughout the world have sedation to enable egg recovery and are very satisfied with it. Sedation is recommended and preferred as the method for this procedure by the National Institute for Health and Clinical Excellence (NICE) and is our technique of choice in this unit. In a recent survey, well over 95% of patients were very happy with their experience and would have sedation again if it was needed. They also benefitted from low rates of nausea and vomiting and a shorter recovery and stay in hospital - often leaving by lunchtime. During the procedure you will be fully monitored, which is routine. The surgeon will reassure you if necessary during the egg recovery procedure, but it is best to relax with the sedation and allow the surgeon to proceed. Although the majority of our sedated patients do not remember any detail of the procedure itself or any discomfort, it is important that you understand that with sedation there is a possibility that you may remember some events during surgery and that you may feel the probe and possibly a little discomfort. Only with general anaesthetic would you be completely unaware. We would strongly recommend that sedation is our preferred method for egg recovery. After a short period of recovery and a bite to eat and a drink the ward nurses will ensure that you are safe to leave us. Typically the whole process takes about 30 minutes, however if you do require a general anaesthesia you would take longer to recover and may have to stay in hospital longer; this is because the dose of anaesthetic is larger and is often different. Please remember that you should not operate any machine, drive or sign important documents until the day after as your judgement may be impaired. This applies to both sedation and anaesthetic. Please ask the fertility nurses if you have any questions about what will happen to you.

Other options

If your sperm is unsuitable for freeze preservation, you may wish, in the long term, to discuss the options of donor insemination or adoption. If you have any questions or worries about sperm preservation, or any of the subjects covered in this leaflet, please do not hesitate to contact the Andrology Department on the telephone number given on the back of this leaflet.

How are the samples produced and stored?

Samples are produced here in Andrology, in a private room, by masturbation. Samples are stored in small, sealed bottles in liquid Nitrogen vapour. These bottles are carefully labelled with your name, date of birth and reference number, and are witnessed by a second member of staff, who also verifies the details. Freezing takes place as soon as possible after the sample is passed, so it is better if the sample is produced on the premises.

Can my wife/partner accompany me?

Yes. You may be accompanied by anyone you choose. This can be your wife, partner, parents, a member of your family or a friend, however, it is not essential and you will be seen alone if you prefer. After you have passed your first sample, you will be asked to wait while the sample is assessed for quality. You will be told about the results of the assessment and, provided there are sperm which are alive in the sample, it will be frozen for you. In general, sperm quality varies and some samples freeze better than others. For this reason, we cannot guarantee that freezing will be successful. If you wish, we can offer you further appointments at this time.

How long can sperm be stored?

By law, sperm can be stored up to 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?

Whilst we do everything possible to ensure the safety of your samples, we cannot guarantee against all 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.

When can we use the sperm?

You can use the sperm at any time. Patients often like to wait until they have recovered from their medical or surgical treatment. When you wish to consider a pregnancy, you and your wife/partner should go to see your General Practitioner (GP), who would then refer you to the Assisted Reproductive Unit. You can be seen here at Saint Mary’s or in a hospital/unit closer to your home. However, we are only allowed to transfer samples to hospitals/units which hold licences issued by the Human Fertilisation and Embryology Authority (HFEA). Your GP will be able to find this information for you.

How are the samples used?

There are a number of options which may be open to you. The main ones are: • IUI Intra-uterine Insemination • IVF In Vitro Fertilisation • 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?

Each method has a different success rate, and a lot will depend on the potential fertility of your wife/partner. Standard gynaecological tests on your wife/partner would normally be arranged. recommended before using your stored semen, and these can be Frozen sperm, however, is not as fertile as fresh sperm and we are unable to guarantee that a pregnancy will result from its use. All this will be explained to you when you and your wife/partner are seen by the doctor.

Counselling

Infertility counselling is available at Saint Mary’s Hospital and appointments to see the counsellor 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. Your GP will need to send a referral letter for this.

Family planning during treatment

There is no definite proof that your chemotherapy/radiotherapy will cause changes to your sperm, which could affect any children conceived during this treatment. However, it is advisable for you to use some form of contraception during the treatment and for twelve months after it finishes, as a precaution.

Repeat tests

You may wish to check whether your treatment has affected your fertility. Some men recover their fertility after treatment, and if you want a sperm count at any time after banking, please telephone (0161) 276 6473 for an appointment. Please allow six months to elapse from completion of your chemotherapy/ radiotherapy treatment before contacting us.

What is the IONA® test?

The IONA® test is a non-invasive prenatal test (NIPT) for pregnant women which estimates the risk of a fetus having Down’s syndrome or some other serious genetic diseases. The IONA® test is an advanced screening test that is carried out on a small maternal blood sample. Pregnant women can expect test results from their healthcare provider within approximately 3-5 days from sample receipt

What does 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). Trisomies occur when three, instead of the usual two, copies of a chromosome are present. Edwards’ and Patau’s syndromes are much rarer than Down’s but are very serious and many affected babies do not survive. The IONA® test also offers optional fetal sex determination.

What are the advantages of the IONA® test?

  • Safe: non-invasive with no risk of miscarriage.
  • Fast: the IONA® test is the fastest NIPT available with results provided within 3-5 working days, from sample receipt.
  • Accurate: greater than 99% for detection of trisomy conditions. Fetal sex determination is greater than 97% accurate. Simple: uses a simple maternal blood sample.
  • Local: unlike other NIPT’s, the IONA® test is performed in a laboratory local to you. So your blood sample is not shipped to the US or China.
  • Quality: unlike other NIPT’s, the IONA® test is a regulated diagnostic, which is CE marked.

How does it work?

How does it work? During pregnancy the placenta leaks cell-free DNA which circulates in the maternal bloodstream. As a result, a maternal blood sample contains a mixture of fetal and maternal circulating DNA. The IONA® test directly measures the amount of this cell-free DNA and can detect small changes in the DNA ratio between the maternal and cell-free DNA when a fetal trisomy 21, 18 or 13 is present.

Why is IONA® better than the current combined test?

Traditional screening offered during pregnancy is currently called the combined test. This is an ultrasound scan to measure the nuchal translucency (NT) and a blood test. This is much less accurate than NIPT and it only detects around 85% of babies with Down’s syndrome. The IONA® test has a higher detection rate than the current combined test offered to pregnant women. This means that fewer pregnant women will undergo unnecessary invasive follow-up procedures such as amniocentesis or CVS* which are stressful, painful and can carry a small risk of miscarriage.

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.
  • Unsuitable for women with cancer or with a trisomy or who have undergone a blood transfusion within the       last 12 months.

How are the IONA® results reported?

  • Low Risk: means that it is very unlikely your pregnancy is affected by trisomy 21, 18 or 13.
  • High risk: means that your pregnancy is at  increased risk for trisomy 21, 18 or 13 and the result should be     confirmed by a follow up invasive procedure such as amniocentesis.
  • No result: In  rare cases there is insufficient fetal DNA in    the sample to obtain a result. You may be asked    by your healthcare  provider for an additional  blood sample.
The IONA® test is a screening test. Suitability for and results from the test must be discussed in detail with your healthcare  provider.

About Prasad Hospital:

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

As a routine part of infertility investigation, you have been asked to provide a semen sample for assessment of sperm number and quality.

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. NOTE: USING A PUBLIC TOILET TO PASS YOUR SAMPLE IS AGAINST THE LAW.

Instructions for collecting the semen sample

  • You should abstain from intercourse or masturbation for three to four days prior to providing the specimen.
  •  The sample must be obtained by masturbation (manual stimulation) and should be collected directly into the specimen container provided. 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 unlabelled or poorly labelled 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, for example by carrying it in an inside pocket. Excessive cold or heat can 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.  Surgically retrieved sperm are used in an IVF/ICSI treatment cycle to achieve pregnancy.

What is surgical sperm retrieval (SSR) and what does this treatment involve? 

SSR is a technique for collecting sperm directly from a man’s testicles or epididymis. It is a procedure usually carried out as a day case under general anaesthetic. An SSR is usually planned in advance, 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 clinical team may use different methods of SSR. Your hormone (FSH) level and testicular size will determine the method of SSR. Your surgeon will advise you which procedure will be suitable for you.

Who may benefit from surgical sperm retrieval (SSR)?

SSR is intended to help men who have no sperm in their ejaculate or less commonly for men with extremely low quality sperm.  This can be the result of a number of causes:
  •  Men who have had a vasectomy (the male sterilisation 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. A blockage in the epididymis, (the structure connecting the testis to the vas deferens). This can be due to previous testicular surgery/trauma or any previous infection in the genital region.
  • Men who do not produce sperm in their semen, for example in cases of retrograde ejaculation.
  • History of undescended testes and any testicular surgery.
  • Illness (such as mumps in adolescence affecting the testis).
  • May be suitable for men with spinal injury and where there are problems with normal ejaculatory function (such as Multiple sclerosis, Diabetes).
  • Men with congenital or acquired endocrine conditions (hormone producing condition for spermatogenesis).
  • Men with genetic condition (eg. Klinefelter syndrome).
  • Medications (eg steroids, testosterone, opoids).
Most of these men produce healthy sperm in the testicles which can be retrieved by SSR. Unfortunately some men have testicles that fail to produce any sperm at all. For some of these men it may be possible to surgically retrieve sufficient sperm directly from the testes for use in the assisted reproduction treatment (IVF/ICSI).

Pre-operative (pre-op) appointment

Once you are listed for SSR, you will be sent a separate appointment to see a consultant in order 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. This will be held in the Admissions Department, which is based in the new Saint Mary’s Hospital building. This appointment will involve an assessment to ensure that you are fit and well to undergo the procedure.

What are 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 individual case.

 1. Percutaneous Epididymal Sperm Aspiration (PESA)

PESA is performed in theatre at the Old Saint Mary’s Hospital, 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. This fluid is then inspected immediately by embryologists under a microscope for sperm content and motility. The procedure takes about 20-30 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 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. Fluid is collected under microscope and taken for microscopic examination by embryologists to see if there is any viable sperm.

4.  Testicular Sperm Extraction (Open conventional TESE) 

If no sperm is found in PESA, TESA or MESA, TESE will be performed.  This procedure is performed in the New Saint Mary’s Hospital.  There are two ways of performing TESE procedure:
  • Single biopsy (unifocal)
If the hormone level and testicular size is 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 local anaesthetic 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 anaesthetic and nerve block to the genital region. This provides pain relief for 15-16 hours. This procedure will cause some pain and tenderness afterwards, however full recovery is expected within a few days. Samples are passed to the laboratories where an embryologist checks it for sperm suitable for use in further treatment. 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 fertilise an egg.  However, surgically retrieved sperm are 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 fertilise 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).  Fertilisation rates are dependent upon quality of sperm and oocytes (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 fertilisation 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, haematoma (swelling of testicles with blood in the testicle) that would require immediate exploration of testicle within few hours of surgery.  The risk of these complications occurring is small.  There is very small risk of testicular damage and chronic testicular pain, but these occur rarely.  Any procedure that requires a general anaesthetic also carries an increased risk of complications of anaesthesia.

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.

Prior to your procedure

You will be required to fast (this includes no chewing gum and sucking on sweets) for at least 6-8 hours prior to 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 minimise 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 the 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 hour period.

Introduction

This leaflet has been designed to help you understand some of the issues relating to surrogacy. However this leaflet does not replace seeking your own independent legal advice which we strongly advise that you do before proceeding with surrogacy treatments.

What is surrogacy?

Surrogacy is when a woman carries a baby for a couple who are unable to conceive or carry a child themselves for medical or physical reasons. The intended parent(s) are person or persons who become the legal parent(s) of a child born through surrogacy. There are two types of surrogacy:
  • Traditional Surrogacy: This is a pregnancy where the surrogate is genetically related to the baby and becomes pregnant through artificial insemination. While this used to be common, most surrogacy arrangements today involve host surrogacy.
  • Host surrogacy is when IVF is used, either with the eggs of the intended mother, or with donor eggs. The surrogate mother therefore does not use her own eggs, and is genetically unrelated to the baby. There are three stages to ‘host’ surrogacy:
  • Egg donation
The female intended parent, or an egg donor, undergo special procedures to extract a number of eggs.
  • Fertilisation
The eggs are fertilised 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 having been de-frosted from storage. For a fresh embryo transfer the cycles of the surrogate and the egg donor must be synchronised, 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.

Legal rights

Surrogacy is not regulated by the Human Fertilisation and Embryology Authority (HFEA). Surrogacy agreements are unenforceable in England and therefore any patients seeking this treatment must seek independent legal advice.

The birth mother

At present, the Law states that the woman who gives birth to the child is the legal mother when the child is born and will have parental responsibility regardless of genetic relation to the child, any contracts or payments.

The intended mother

The commissioning/aspiring mother will not be the mother of the child even if her eggs are used as part of treatment services provided. She has no legal rights in relation to the child by virtue of her eggs being used or under any surrogacy agreement.

The father

The child’s legal father or ‘second parent’ will be the surrogate’s husband or partner unless:
  •  Legal rights are given to someone else through a parental order or adoption.
  • The surrogate’s husband or civil partner didn’t give their permission for their wife or partner to carry the pregnancy.
  • If your surrogate has no partner, or they are unmarried and not in a civil partnership, the child will have no legal father or second parent unless the intended parent actively consents.

Consents

From 1st October 2013, it is possible for one of the intended parents commissioning a surrogacy arrangement to be recognised as the legal parent when the child is born, if the surrogate is not married or in a civil partnership and the relevant consents are in place. These consents will be completed with you and your partner at your clinic appointment with the doctor as applicable.

Screening

Screening of all those involved in surrogacy arrangements will be undertaken in line with HFEA current guidelines before treatment 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 us information about the lining of the womb and the number and size of follicles, and any existing pathology, such as cysts or fibroids, which will help us to decide about your next stage of treatment. Your treatment in the Department of Reproductive Medicine will involve a number of ultrasound scans

Does it hurt?

No.  All the ultrasound scans are internal and are not painful.  It involves a specially shaped ultrasound probe (slightly bigger than a tampon) being inserted into the vagina. Some patients may find it a little uncomfortable, but it is not as bad as a smear test.  The probe is cleaned and covered before use for each patient.

Why vaginally? 

The ultrasound scans are performed transvaginally because they can be done with an empty bladder.  It provides a better image of your pelvic organs so we can get the maximum amount of information.  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 your vagina and pictures of 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?

You will be asked to undress from the waist down, including your underwear, and lie on the ultrasound couch with a pillow under your bottom.  (You may find it more convenient to wear clothing that is easy to remove below the waist).  You will be asked to bend your knees, then we carefully insert the ultrasound probe into the vagina.

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

You may have several scans during the course of your treatment, depending upon the treatment you require, the medication you are taking and how you respond to the drugs. The first scan can be done anytime in your menstrual cycle, including during your period. This scan is called a ‘baseline’ scan and is to document any pathology within the uterus or ovaries before the treatment begins. For patients using stimulation drugs during treatment, the second scan is one week later and then the scans are usually repeated at intervals to check for follicles. When the follicles get bigger, we measure them. This can sometimes take a while depending on how many follicles there are. We perform three different measurements on each follicle and work out the average diameter in millimetres.

Can my partner stay with me?

You may bring your partner with you 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 practise at scanning but we will ask your permission first.

What time are the scans performed? 

The scans are done throughout the morning; the first appointment is at approximately 8.30 am.  You will be given an appointment time for your scan.  Where possible your blood and scan appointments will be planned around the same time, however, this is not always possible and there can sometimes be a delay between them.

What if I am unsure about something?

Please feel free to ask any questions. 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 theatre for egg retrieval, Intrauterine Insemination or Induction of Ovulation. (The eggs are invisible to the naked eye and cannot be seen on the scan.)  The clinical team will decide on the timing of this.
  • Cysts: These are little sacs of fluid, blood or other components. Sometimes we see them on the baseline scan.
  • Hydrosalpinx: Fluid in the fallopian tubes, sometime we see this during the treatment, it can be a side effect of the medication or associated with blocked fallopian tubes.
  • Fibroids: Thickened lumps of muscle within the muscle of the uterus. We measure these and check whether they are pressing on the cavity of the womb.
  • Polyps: Benign (non cancerous) growths that can be found on the lining of the womb and may cause problems with the embryo implanting easily.

 Information About this

This information is for you if you would like to know about your baby’s movements during pregnancy. It may also be helpful if you are concerned that your baby has not been moving as much as usual or if you feel that your baby’s movements have changed. It tells you about:
  • what are normal movements for an unborn baby
  • what affects how much you feel your baby move
  • what you should do if your baby’s movements are reduced or changed
  • what care you will have if your baby’s movements are reduced or changed.
This information aims to help you and your healthcare team make the best decisions about your care. It is not meant to replace advice from a doctor or midwife about your own situation.

What are normal movements for an unborn baby in pregnancy? 

Most women are first aware of their baby moving when they are 18–20 weeks pregnant. However, if this is your first pregnancy, you may not become aware of movements until you are more than 20 weeks pregnant. If you have been pregnant before, you may feel movements as early as 16 weeks. Pregnant women feel their unborn baby’s movements as a kick, flutter, swish or roll. As your baby develops, both the number and type of movements will change with your baby’s activity pattern. Usually, afternoon and evening periods are times of peak activity for your baby. During both day and night, your baby has sleep periods that mostly last between 20 and 40 minutes, and are rarely longer than 90 minutes. Your  baby will usually not move during these sleep periods. 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. Often, if you are busy, you may not notice all of these movements. Importantly, you should continue to feel your baby move right up to the time you go into labour. Your baby should move during labour too.

Why are my unborn baby’s movements important?  

During your pregnancy, feeling your baby move gives you reassurance of his or her wellbeing. If you notice your baby is moving less than usual or if you have noticed a change in the pattern of movements, it may be the first sign that your baby is unwell and therefore it is essential that you contact your midwife or local maternity unit immediately so that your baby’s wellbeing can be assessed.

How many movements are enough?

There is no specific number of movements which is normal. During your pregnancy, you need to be aware of your baby’s individual pattern of movements. A reduction or a change in your baby’s movements is what is important.

What factors can affect me feeling my baby move?

You are less likely to be aware of your baby’s movements when you are active or busy. If your placenta (afterbirth) is at the front of your uterus (womb), it may not be so easy for you to feel your baby’s movements. Your baby lying head down or bottom first will not affect whether you can feel it move. If your baby’s back is lying at the front of your uterus, you may feel fewer movements than if his or her back is lying alongside your own back.

What can cause my baby to move less?

Certain drugs such as strong pain relief or sedatives can get into an unborn baby’s circulation and can make your baby move less. Alcohol and smoking may also affect your baby’s movements. In some cases, a baby may move less because he or she is unwell. Rarely, a baby may have a condition affecting the muscles or nerves that causes him or her to move very little or not at all.

Should I use a chart to count my baby’s movements?

There is not enough evidence to recommend the routine use of a movement chart. It is more important for you to be aware of your baby’s individual pattern of movements throughout your pregnancy and you should seek immediate help if you feel that the movements are reduced.

What if I am unsure about my baby’s movements?

If you are unsure whether or not your baby’s movements are reduced, you should lie down on your left side and focus on your baby’s movements for the next 2 hours. If you do not feel ten or more separate movements during these 2 hours, you should take action (see below).

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

Always seek professional help immediately. Never go to sleep ignoring a reduction in your baby’s movements. Do not rely on any home kits you may have for listening to your baby’s heartbeat. The care you will be given will depend on the stage of your pregnancy:
  •  Less than 24 weeks pregnant Most women first become aware of their baby moving when they are 18–20 weeks pregnant. If by 24 weeks you have never felt your baby move, you should contact your midwife, who will check your baby’s heartbeat. An ultrasound scan may be arranged and you may be referred to a specialist fetal medicine centre to check your baby’s wellbeing.
  • Between 24 weeks and 28 weeks pregnant You should contact your midwife, who will check your baby’s heartbeat. You will have a full antenatal check-up that includes checking the size of your uterus, measuring your blood pressure and testing your urine for protein. If your uterus measures smaller than expected, an ultrasound scan may be arranged to check on your baby’s growth and development.
  • Over 28 weeks pregnant You must contact your midwife or local maternity unit immediately. You must not wait until the next day to seek help. You will be asked about your baby’s movements. You will have a full antenatal check-up, including checking your baby’s heartbeat. Your baby’s heart rate will be monitored, usually for at least 20 minutes. This should give you reassurance about your baby’s wellbeing. You should be able to see your baby’s heart rate increase as he or she moves. You will usually be able to go home once you are reassured. An ultrasound scan to check on the growth of your baby, as well as the amount of amniotic fluid around your baby, may be arranged if:
  • your uterus measures smaller than expected
  • your pregnancy has risk factors associated with stillbirth
  • the heart-rate monitoring is normal but you still feel that your baby’s movements are less than usual.
The scan is normally performed within 24 hours of being requested. These investigations usually provide reassurance that all is well. Most women who experience one episode of reduction in their baby’s movements have a straightforward pregnancy and go on to deliver a healthy baby. If there are any concerns about your baby, your doctor and midwife will discuss this with you. Follow-up scans may be arranged. In some circumstances, you may be advised that it would be safer for your baby to be born as soon as possible. This would depend on your individual situation and how far you are in your pregnancy.

 What should I do if I find my baby’s movements are reduced again?

When you go home you will be advised to keep an eye on your baby’s movements and, should your baby have another episode of reduced movements, you must again contact your local maternity unit immediately. Never hesitate to contact your midwife or local maternity unit for advice, no matter how many times this happens.