Here are some frequently asked questions.

Fertility FAQs

A number of factors have been shown to reduce the quality of eggs and sperm, so there are a number of things you can do to minimise this risk, and provide the best conditions possible for the development of your reproductive cells. These types of cells are created over a prolonged period of time, so the modification of lifestyle must be considered as a long term investment. You can find out more in our Lifestyle Advice section.

You need four things to get pregnant:

  1. you need to produce an egg (ovulation),
  2. you need good quality sperm,
  3. then the egg and the sperm need meet and fuse (fertilisation).
  4. the resulting embryo must then implant in the womb.

It sounds relatively simple, but in fact hundreds of synchronised hormonal and physical events must take place and there are many steps where things can go wrong.

“Infertility” is defined as the failure to get pregnant after one year of having regular, unprotected intercourse.

Around 1 in 6 couples have difficulty in conceiving, and this proportion is increasing, largely because women are starting their families later in life and because sperm counts are falling. However, with the appropriate help, the vast majority of couples can realise their dream.

There are many reasons why you might be having difficulty getting pregnant but broadly they are due to problems of ovulation and egg quality, problems of sperm quality, problems with the fallopian tubes, or a combination of these.

Common egg problems:

  • Polycystic ovary syndrome.
  • Being over- or underweight
  • Medications that affect ovulation
  • Increasing age. Unfortunately, as a woman gets older, the quality of her eggs decreases.

Common sperm problems:

It is thought that environmental pollutants are resulting in increasing sperm problems. As a result, we are seeing more men with:

  • Too few sperm
  • Not enough motile (active) sperm
  • Minor genetic problems that affect sperm counts and quality
  • Genetic problems or past infection.

Common fallopian tube problems:

  • Past pelvic infection
  • Past pelvic surgery

Endometriosis:

Endometriosis is a common condition where the cells that line the womb (and bleed each month with a menstrual period) occur outside the womb. Even mild endometriosis can have a negative effect on a couple’s fertility.

Unexplained infertility

In a proportion of couples we can’t find an obvious cause and this is termed “unexplained infertility”. It doesn’t mean that there is nothing wrong, it just reflects our current state of knowledge and it might be due to a subtle problem with one of the hundreds of things that are required for successful conception and implantation.

Female fertility FAQs

Your level of AMH helps to predict how well your ovaries will respond to stimulation during an IVF cycle. It can be used to tailor the stimulation drugs to an individual patient and can predict which patients may expect low or high egg numbers and even patients at a higher risk of ovarian hyperstimulation syndrome (OHSS). Patients with a low AMH or a low antral follicle count do have lower pregnancy rate but the severity of this reduction is age related, with patients ≥39 yrs have a significantly lower chance of pregnancy than patients with the same AMH who are less than 39yrs. Pregnancies have been reported in patients with very low, or barely detectable AMH levels. Patients with a low AMH (less than 3.08 pmol/l) also have an increased risk of failed fertilisation across all age groups.

Male fertility FAQs

Sperm are produced in the testes. Sperm develop inside very small tubules in testicular tissue (seminiferous tubules) and then move along a network of tubes to a holding place (the epididymis) before ejaculation. In the average man with a normal sperm count, the testes produce thousands of sperm every second, but it takes three months for these to become mature and be ready to be ejaculated.

There are several ways to test male fertility, but these depend on the outcome of the initial semen analysis. For men with normal numbers of sperm with good motility we don’t typically offer further tests, as their results don’t influence treatment or treatment outcomes. For men with abnormal sperm results, we follow a pathway which may involve blood tests, genetic studies and testicular exploration. The semen analysis is the most important test, and the place to start.

Sperm sample FAQs

This will depend on the reason you need the procedure. Men who have no sperm in their ejaculate due to a blockage have a higher chance of retrieving sperm than men who have testicular failure. Retrieval rates range between 25-75% but please speak to your doctor at your consultation for a more accurate estimation based on your own diagnosis.

We will speak to every couple on the day of treatment about their sperm quality and discuss the best treatment option. If the sample is poorer than expected, we may need to use a procedure called ICSI. This is where we inject a single sperm into each egg to help maximise fertilisation rates, and can be done with very small numbers of sperm. If numbers are extremely low or we fail to find sperm on the day of treatment, we may be able to do a surgical procedure SSR to recover sperm for treatment.

If you are concerned that you may struggle to produce a sample on the day of treatment please speak to an embryologist about freezing (vitrifying) a sample prior to treatment which can be used as a back-up: this can help to alleviate stress on the day. If we do not have a semen sample on the day of treatment, we may be able to extract sperm surgically, or vitrify the eggs to commence treatment at a later date.

For the best result, you must abstain from ejaculation for a minimum of 3 and a maximum of 5 days (See: Can we have sex during treatment or before a sperm sample?). Wash your hands and genitals before you produce the semen sample. You must tell the clinic about any illness or medication taken in the last three months, as these things can affect your semen quality, and the advice you’re given after the analysis.

If producing a sample at the clinic is unsuitable or unsuccessful, or if you are concerned that you may have difficulties, please speak to a member of staff about alternative arrangements. It may be possible to produce a sample at home. You will be provided with an appropriately labelled sterile pot and a sealable plastic specimen bag for transport. You must ensure that the sample can be transported at a temperature between 20 -37  degrees C (we suggest close to your body/ inside jacket pocket) and within 1 hour of production. You will also need a form to state that the sample is your own. You must inform a member of staff if the whole sample was not collected. Spillage of the sample can affect the results and subsequent treatment plans.

It is best to produce the semen sample on-site at the clinic. A discreet and quiet room is provided. We will do our best to make you comfortable and relaxed; you may wish to have your partner with you, but please be aware that this isn’t always possible. You must inform a member of staff if the whole sample was not collected. Spillage of the sample can affect the results and subsequent treatment plans.

IVF/ICSI Treatment FAQs

Many couples remain intimate during treatment and this is perfectly fine in most cases. There are times when unprotected intercourse is best avoided and this will be clarified during treatment as it is different for different couples.
One occasion when we can give general advice is before a sperm sample is provided for analysis or treatment. It is important to avoid ejaculation for a few days as this affects the result and both the number of sperm and their motility. The highest number of sperm and best motility are typically seen after a man has abstained for between 2 to 7 days. Abstaining for longer than this may increase the number of sperm but the proportion of sperm still ‘swimming’ falls. In contrast, ejaculating every day may increase sperm motility but the numbers will be lower. The 2 to 7 rule is the best compromise therefore between concentration and motility.

The standard course of drugs for an antagonist cycle is 14 days, over 90% of our fresh cycles are now antagonist (mild) cycles. If it is necessary to have a long cycle, the drug course lasts around 4 weeks. After this you will have your egg collection procedure. 3 or 5 days after your egg collection you will generally have your embryo transfer. This is the standard time taken for IVF cycles but individual circumstances may alter these timings slightly.

IVF (In Vitro Fertilisation) is where a high number of (prepared) sperm are added to a dish containing the eggs and the sperm are left to swim to the eggs on their own. The sperm & eggs are left together overnight and checked for fertilisation the following morning.
ICSI (Intra Cytoplasmic Sperm Injection) is where a single sperm in injected into an egg by an embryologist. This technique may be used if the sperm concentration or motility are low or if poor fertilisation had been achieved previously with IVF.

You can read about treatment protocols on the IVF treatment page.

Blastocyst FAQs

Approximately 40% of embryos will reach the blastocyst stage. Those at a compacting or cavitating stage (the stage before the blastocyst stage) can still be transferred but do have a lower chance of achieving a pregnancy. There is a small chance that all of patients’ embryos may stop developing at the embryo stage, this happens in approximately 2% of blastocyst cycles and results in the embryo transfer been cancelled.

‘Blastocyst culture’ is the term commonly used to describe the culture of embryos until they are five days old. A blastocyst has a large number of cells and consists of two distinct cell types. Around 40% of embryos will reach the blastocyst stage and those that do have a higher chance of implanting once transferred.

 

Embryo Transfer FAQs

Success in IVF treatment is determined by a large range of factors. Your doctor is the best person to advise you about your chances of success, as they have all the information about your treatment programme. You can find the latest results from this clinic, and comparisons to national and nearby success rates here.

Embryos which are not transferred can be frozen if they are of a suitable quality. At the time of embryo transfer the Embryologist will discuss with you the quality of the embryos for transfer and any remaining embryos and will advise you if these meet the criteria for freezing. On average we freeze for approximately 25% of patients.

If you have been recommended for SET you are a patient with a high chance of achieving a pregnancy from IVF treatment. A high chance of pregnancy is accompanied by a higher risk of twins, and a higher risk of complications, if we replace two embryos.

Frozen Embryo Transfer FAQs

Our aim is to give you the best chance possible of pregnancy with each frozen embryo replacement cycle. Not all embryos have equal potential to form a pregnancy and each will be affected differently by the freeze and thaw process. This may not be immediately clear to us after thawing. For this reason we usually thaw more embryos than you would like to have transferred back to the uterus. This gives the embryologist a chance to select the best quality & highest surviving embryos from a group and therefore gives you a higher chance of pregnancy. If you have embryos frozen at the day 2/3 stage of development we will usually recommend thawing at least 4 and culturing them in our incubator until the blastocyst stage to help us choose the best embryos. If you have embryos frozen at day 5 of development (blastocysts) we will usually recommend thawing at least one more than you wish to have transferred. Blastocysts are thawed and transferred back to the uterus on the same day.

Frozen embryos are stored in liquid nitrogen at a temperature of -196°C. This means they are held in a suspended state and do not deteriorate with time in storage.

We find approximately 80% of frozen embryos survive the freezing/thawing process. This can vary depending on the stage of development that the embryos were frozen and an individual patients’ embryos susceptibility to the process.

Vitrification FAQs

Frozen embryos are stored in liquid nitrogen at a temperature of -196°C. This means they are held in a suspended state and do not deteriorate with time in storage.

We will send you a letter before the period of storage is due to end. This will outline your options and include a consent form for you to return to us. If you don’t reply to this first letter promptly, we will send you a second letter, attempt to contact you by phone and contact your last known GP.
Your choices at the end of the storage period are: to use the embryos/sperm for treatment before the end of the consent period, extend storage, to discard the embryos/sperm if you no longer plan to have treatment, or to donate to another couple or to research (applicable in some circumstances).

We offer egg freezing for women, who wish to preserve their fertility and have children later in life. Please visit the Fertility Preservation page for more details.

Donor FAQs - Sperm

Yes, the Human Fertilisation and Embryology Authority (HFEA) states that up to 10 families can be created from each donor. You may choose to restrict the number of families to less than 10 if you wish. There is more information available regarding this on the HFEA website.

If a child is born as a result of your donation, they are able to find out detailed information about you once they reach 18 years of age and this information could lead to them identifying you. There is more information available on this subject on the National Gamete Donation Trust website.

Clinic & General FAQs

Yes, we receive donations from women who are prepared to do something amazing by donating some of their own eggs for use in our fertility programme (altruistic egg donors) or donations from someone known to the recipient patient (known egg donors).

There is no standard fee for fertility treatment as there are a number of complex factors that will vary for everyone, such as the amount of medication needed. For a detailed breakdown of the pricing structure for the different stages of the process and the auxiliary services available, as well as a list of price examples, please visit our Prices section.

Before treatment

A fibroid is a benign (non-malignant) tumour or overgrowth in the muscle layer of the womb. They are very common and can range in size from very small (less than the size of a pea) to very large (the size of a grapefruit). Depending on the location of the fibroid, surgery may be required to remove it.

An endometrial polyp is a benign (non-malignant) tumour or overgrowth of the lining of the womb. They are very common and can be solitary or multiple. The majority of polyps do not cause any problems but in a small number of cases they may interfere with implantation and increase the risk of miscarriage.

An ovarian cyst is simply a fluid-filled sac. Cysts are often solitary but can be multiple and affect both ovaries. There are many different types of ovarian cyst all of which require different treatment. In certain circumstances it may be necessary to remove or aspirate the cyst before commencing treatment.

Donating Eggs - FAQs

Yes, the Human Fertilisation and Embryology Authority (HFEA) states that up to 10 families can be created via each donor. You may choose to restrict this number to less than 10 if you wish. Egg donors donate all their eggs to one recipient per cycle so this will only count as one family. However further children for that family may be born as a result of any frozen embryos used in subsequent cycles. The number of children born as a result of your donation will, therefore, partially depend on the number of times you choose to donate and the number of embryos created for each couple. There is more information on this on the HFEA website.

If a child is born as a result of your donation, they are able to find out detailed information about you once they reach 18 years old. This information could lead them to identifying you. There is more information available on this subject on the National Gamete Donation Trust website.

If you are an altruistic donor, recipients will not be told your identity. You will complete a characteristics form that will aid the recipients in choosing a donor but no personal information will be disclosed.

No, the recipient couple are the parents of any resultant child; you have no financial or legal obligation or responsibility.

Yes, this is possible. When you are sterilised your fallopian tubes are clipped/removed, but your ovaries continue to work normally and we can recover the eggs produced.

Yes, all women are born with more eggs than they use. Within a couple of months of completing a donation cycle your natural cycle should return.

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