Gynaecology Leaflet: Fertility Unit Welcome Pack

Leaflet Details

Patient Information

Contents

• Welcome to the fertility unit
• Meet the team
• Our aim
• About fertility
• Getting started
• GP referral
• Your first consultation
• Treatment options
• Support
• Contact us

Welcome to the fertility unit

The Fertility unit is a specialist gynaecology service with clinics and theatres located at both St Peter’s Hospital and Ashford Hospital.

It provides a one-stop comprehensive assessment for couples who have difficulties conceiving and offers individualised treatments according to their needs.

We offer a full range of investigations including blood tests, semen analysis, ovarian reserve testing, transvaginal ultrasound, tubal patency testing - Hysterosalpingogram (HSG) and Hysterosalpingo-contrast-sonography (HyCoSy), as well as laparoscopic and hysteroscopic surgery.

We also offer a dietitian service to assist in weight loss to aid fertility.

We have a counselling service which can be accessed during treatment as required.

Treatments offered include ovulation induction with follicle tracking, fertility surgery and assisted conception.

Assisted conception treatments including In Vitro Fertilisation (IVF) and Intracytoplasmic Sperm Injection (ICSI) treatments are offered in partnership with the CCG approved IVF units. Eligibility for NHS fertility treatments is in accordance with the local CCG policies on the provision of fertility services.

Specialized Andrology support is provided through the Urology department here at Ashford and St Peter’s Hospital.

Severe Endometriosis treatment is provided through the Centre of Endometriosis and Minimally Invasive Gynaecology (CEMIG), which gives you access to dedicated surgeons with expertise in advanced gynaecological endoscopic surgery.

Meet the team

Our friendly and very experienced team consists of a consultant, clinical fellow with an interest in fertility, specialist nurse, an admin co-ordinator and other support staff.

Our aim

We aim to provide a high-quality personalised service in a caring and compassionate multi-disciplinary environment and place our patients and couples at the centre of their care.

About infertility

About 1 in 7 couples (around 3.5 million people) in the UK have difficulty conceiving. About 84% of couples will conceive naturally within a year if they have regular unprotected sex (every 2 or 3 days). For couples who've been trying to conceive for more than 3 years without success, the likelihood of getting pregnant naturally within the next year is 25% or less.

What causes infertility?

There are many reasons why some couples have difficulty conceiving. Some of the main reasons are:

• Ovulatory problems (25%)
   
• Damage to the fallopian tubes (20%)
   
• Problems with the sperm for example low count or quality (30%)
   
• Gynaecological problems such as endometriosis (10%)

In about 30% of cases there may be problems in both the man and the woman.

Lifestyle factors such as being overweight or underweight, smoking and age may also play a role. However, in about 25% of couples there may also be no identified cause. This is then known as “unexplained subfertility”.

Some women do get pregnant very quickly, but for others it can take longer. NICE guidance suggests that women who have not conceived after 1 year should be offered further assessment and investigations along with her partner. As fertility decreases with increasing age, women over the age of 36 or women with factors that are known to affect fertility should be offered earlier investigations. Your GP may arrange some basic investigations and offer advice or referral to the fertility clinic.

Getting started

You can potentially boost your chances of conceiving by making sure your body is healthy enough to become pregnant and support a developing baby.

Both men and women can make lifestyle changes that may make them more likely to conceive.

All women who are trying to conceive should have 400 mcg of folic acid daily to prevent the baby from having neural tube defects and Vitamin D supplements.

In addition to that you should also be immunised for Rubella infection.

EAT HEALTHILY

A balanced diet will help ensure your body is healthy enough to become pregnant and can also help to keep sperm production at optimum levels.

EXERCISE REGULARLY

Regular exercise will keep you fit and help you to maintain a healthy weight. It can also help to reduce your stress levels, in what can be an emotionally draining situation. NHS IVF funding is not available for women with a BMI is over 30.

DRINK SENSIBLY

Alcohol may affect fertility and sperm quality, so aim to limit your drinking to the guidelines of two to three units a day for women and three to four units a day for men.

MEDICATION AND DRUGS

Some prescription drugs can reduce your chances of conceiving, so if you are taking regular medication ask you GP about suitable alternatives. All illegal drugs should be completely avoided.

STOP SMOKING

Smoking has been linked to infertility and early menopause in women and has been shown to reduce sperm quality. It is also a factor in premature low birth-weight babies.

KEEP COOL

For maximum sperm production, the testes should be a couple of degrees cooler than the rest of your body. It may help to avoid tight-fitting clothing, saunas and hot showers.

GP referral

Your GP will carry out the following tests prior to referral:

Female partner:

• Day 2 - 5 FSH, LH and Estradiol (E2)
   
• Day 21 Progesterone (if 28-day cycles)
   
• Rubella immunity
   
• Cervical smear (within the last 3 years)
   
• Cervical swab for Chlamydia.

Male partner:

• Semen analysis - you may be asked to repeat it if the first sample is inadequate or indicates a problem. You should abstain from ejaculating for 3 to 4 days before your test.

Please ensure you have completed these investigations before your first consultation with the doctor. We may need to reschedule your appointment to allow completion of these tests.

Your first consultation

You will be seen by a member of the fertility team, and it may be a virtual appointment, and a complete history will be taken of you and your partner. You will then have a subsequent medical consultation with one of the doctors who will review your medical history and may perform an examination which may include a transvaginal ultrasound scan. You may then be referred for further investigations and be offered some initial treatment. Once all your test results are known - you are ready to start treatment.

The following appointments and investigations are available:

• Fertility blood tests, including Anti-Mullerian Hormone testing (AMH)
   
• Chromosomal analysis, if there are any abnormalities found on semen analysis
   
• Pre assessment pelvic scan
   
• HyCoSy (a tubal patency investigation)
   
• Follicular tracking scans
   
• Early pregnancy scans
   
• Counselling service

Treatment options

There are three main types of fertility treatment which are subject to patient eligibility:

• Drugs to assist fertility
   
• Fertility surgery
   
• Assisted conception

Drugs to assist fertility

The most common reason for a delay in conceiving is problems with ovulation, and the main cause of this is polycystic ovarian syndrome. We have a great deal of experience in managing ovulation disorders with medications, follicle tracking and appropriately timed intercourse.

Surgery

• Laparoscopic surgery - laparoscopic (keyhole) surgery can be used to look at the internal organs. This surgery can be used to remove ovarian cysts, fibroids, damaged fallopian tubes and remove endometriosis. This surgery is normally performed as a day case procedure so that you do not require a long stay in hospital.
   
• Hysteroscopic surgery - hysteroscopy may be performed as an outpatient or under general anaesthetic. During this type of surgery polyps and fibroids can be removed and some abnormalities of the womb such as uterine septa can be corrected.
   
• Open surgery - this is performed to remove large multiple fibroids.

Assisted Conception

If you are likely to benefit from IVF or ICSI treatment, then we will help you determine whether you are eligible for NHS funding (please see leaflet on inclusion criteria).

If you are eligible, we will refer you promptly to an IVF provider (please see leaflet on available IVF providers). If you do not meet the requirements for NHS IVF, then we will independently advise you on the self-funded options available to you.

Support

We want to support you through this challenging time. Our doctors are available to give advice whenever you may need it. Please feel free to email us at any time if you have questions about your investigations or treatment.

Contacts and organisations

Miscarriage UK
Support and information for those affected by pregnancy loss
https://www.miscarriageuk.org

The Human Fertility and Embryology Authority (HFEA)
The regulatory body for fertility treatment in the UK
https://www.hfea.gov.uk

British Fertility Society
https://www.britishfertilitysociety.org.uk/

Twins and multiple births association
Support for families with multiple births
https://twinstrust.org/

Verity
The UK charity for women with polycystic ovary syndrome
https://www.verity-pcos.org.uk/

NICE
National Institute for Health and Care Excellence National evidence-based guidelines
https://www.nice.org.uk/

The Fertility Clinic is not responsible for the information supplied by other organisations mentioned in this leaflet.

Contact us

Clinical Office Admin Co-ordinator
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
Tel: 01932 723973