Information for patients
Fertility Clinic
Name: ______
Who to contact and how: ______
Notes: ______
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Diana, Princess of Wales Scunthorpe General Goole & District Hospital Hospital Hospital Scartho Road Cliff Gardens Woodland Avenue Grimsby Scunthorpe Goole DN33 2BA DN15 7BH DN14 6RX 03033 306999 03033 306999 03033 306999 www.nlg.nhs.uk www.nlg.nhs.uk www.nlg.nhs.uk
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Information for patients
Introduction This leaflet will explain what to expect at your first fertility clinic appointment.
Why have I been referred? The usual reason for referral to the Fertility clinic is because you and your partner have been trying to get pregnant for some time and your GP thinks that you need further investigations and possibly treatment. There may be other reasons for referral such as fertility preservation for people with cancer or other serious medical problems. Couples are usually advised to try to get pregnant by having regular intercourse two to three times a week for up to a year before being referred to the fertility clinic. This is because 80% of couples will conceive naturally over this time period. In some cases however, early referral might be appropriate, for example for older women, if the woman’s periods are very irregular or there is a known problem such as blocked tubes or an ‘abnormal’ semen analysis.
What are the causes of infertility? There are many possible causes of infertility, and fertility problems can affect either partner. But in a quarter of cases it is not possible to identify the cause (Unexplained subfertility). Common causes of infertility include: • lack of regular ovulation (the monthly release of an egg) • poor quality semen • blocked or damaged fallopian tubes • endometriosis – where tissue that behaves like the lining of the womb (the endometrium) is found outside the womb
Risk factors There are also several factors that can affect fertility and they include • age – fertility declines with age • weight – being overweight or obese (having a BMI of 30Kg/m2 or over) reduces fertility; in women, being overweight or severely underweight can affect ovulation • sexually transmitted infections (STIs) – several STIs, including chlamydia, can affect fertility • smoking – can affect fertility: smoking (including passive smoking) affects your chance of conceiving and can reduce semen quality; read more about quitting smoking • alcohol – the safest approach is not to drink alcohol at all to keep risks to your baby to a minimum. Drinking too much alcohol can also affect the quality of sperm (the chief medical officers for the UK recommend adults should drink no more than 14 units of alcohol a week, which should be spread evenly over 3 days or more)
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• environmental factors – exposure to certain pesticides, solvents and metals has been shown to affect fertility, particularly in men • stress – can affect your relationship with your partner and cause a loss of sex drive; in severe cases, stress may also affect ovulation and sperm production
What can we do to improve the chance of getting pregnant? There are some lifestyle changes recommended by NICE (National Institute of Health and Care Excellence) to improve the chance of getting pregnant. • Women who have a body mass index (BMI) of more than 30Kg/m2 are likely to take longer to conceive. If women who have a BMI of 30Kg/m2 or over are not ovulating, (producing eggs), losing weight is likely to increase their chances of conception. Participating in a group programme involving exercise and dietary advice leads to more pregnancies than weight loss advice alone. Men who have a BMI of 30Kg/m2 or over are likely to have reduced fertility • If you are a woman with a BMI of less than 19 and have irregular menstruation( periods), or are not menstruating, increasing your body weight is likely to improve your chance of conception • Smoking is linked to reduced fertility in both men and women. Passive smoking is also likely to affect the chance of conceiving • NICE Guidance recommends that women trying to conceive have no more than 2-3 units of alcohol per week. Men should not exceed current guidelines of 3-4 units of alcohol per day • Prescribed, over the counter and recreational drugs can interfere with male and female fertility. Enquiries about these are made in clinic to people who are concerned about their fertility and appropriate advice offered
What tests do we need to have? Infertility is a condition affecting both partners of a couple and both will need to have tests done. It is very important that both of you attend the initial Consultation at the Fertility Clinic. Your GP will arrange for the initial investigations for you both.
Tests for the woman include: • An ultrasound scan of the pelvis, this is to check that the womb and ovaries are normal • Hormone Blood tests – this routine blood test are usually taken between days 1 and 3 of your menstrual cycle. This is called the follicular Phase. Day one is the first day of your period. They may also be taken at any time if your periods are either infrequent or completely absent. The blood tests are called FSH and LH- and are used to investigate whether ovulation (production of an egg) is occurring each month • Progesterone blood test- Progesterone is a female hormone produced by the ovaries after ovulation. It causes the endometrial lining of the womb to get thicker ready for a
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fertilised egg. Progesterone levels increase after ovulation, reaching the highest level seven days before the start of the next period. The progesterone test is used to test whether a woman is ovulating (releasing an egg). In a regular 28 day cycle, the progesterone test is taken on day 21 of a woman’s cycle. If a woman’s cycle is longer or shorter than 28 days the test may be taken later or sooner • Rubella antibody titre blood test. This is performed to check for immunity. Rubella infections in pregnancy can lead to various abnormalities of the developing baby. It can be performed at any time during the cycle. If you are not immune, the vaccination will need to be arranged
Tests for the male Semen analysis- Semen analysis looks in detail at the density, motility and morphology of the sperm. Density means the sperm count that is the number of sperms in a sample. Motility- this is the ability for the sperm to swim. Poor sperm motility means the sperm do not swim well which can mean issues with reaching the egg. Morphology refers to the size and shape of the sperm. Abnormally shaped sperm can be a factor in male fertility.
What happens at the first Clinic appointment? When you first arrive at the Clinic, a Nurse will take your height and weight and calculate your BMI. This will happen for your partner too. A waist to hip ratio will also be taken. This involves taking a measurement around your waist and your hips. Blood pressure and pulse will also be taken. Once you have had these measurements recorded, you will be seen by a Consultant. A detailed medical, sexual and social history will be taken. The Consultant may discuss the following with you both: • Children – you will be asked if either you or your partner have any children together and with previous partners. You will also be asked about problems during pregnancy such as miscarriage or ectopic pregnancy • Length of time trying to conceive • Sex – it might be embarrassing to be discussing your sex life, however it is very important to be honest and open about this because the problem can sometimes be related to difficulty with sex which can be easily overcome • Length of time since stopping contraception. The type of contraception you were using will be taken into consideration to see whether it may be affecting your ability to conceive. Sometimes it can take a while for certain types of contraception to stop working • Medication- the side effects of some medication can affect fertility. The Consultant will ask about any medications you are taking and might discuss alternative treatments with you. You should also tell the Consultant about any non-prescription medication that you are taking including any herbal medicines and recreational drugs
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• Lifestyle- smoking, weight, alcohol consumption and stress can all affect fertility. The Consultant may discuss ways that you could improve your lifestyle and therefore increase your chance of conceiving Once a detailed history has been taken, the Consultant will discuss your results with you any further investigations that may be needed. These may include: • Hysterosalpingogram- this is an X-ray of the womb (uterine cavity) and fallopian tubes. This test is carried out as an outpatient in the X-ray department and usually does not require any form of general anaesthetic. It can cause you to experience a moderate amount of discomfort rather like period pains. The examination is similar to a smear test. A Doctor or radiographer will pass a speculum and then place a small tube into the cervix (the neck of the womb). A special clear fluid is injected into the cavity of the womb which shows up on an X-Ray. If there are no blockages or obstructions, the fluid can be seen filling the womb and then passing along both tubes to enter into the cavity of the abdomen. If this doesn’t happen it may be that there is any obstruction or blockage. The hysterosalpingogram is useful in being able to demonstrate the site of any tubal obstruction and also to show any irregularity in the shape of the cavity of the womb • Laparoscopy – This test will require admission to hospital as a day case. It will be performed under a general anaesthetic. A tiny incision is made at the tummy button and the abdominal cavity is filled with gas to create more space to see the pelvic organs. A slim telescope called a laparoscope is inserted into the abdominal cavity and the womb, tubes and ovaries are thoroughly inspected to check for pelvic problems such as endometriosis and fibroids. Dye is injected into the womb through the cervix. If the tubes are healthy, the dye can be seen passing along them and escaping through the outer openings of the tubes • A repeat semen analysis may be required depending on the initial results
What happens next? You will be given the opportunity to ask any questions at the end of your appointment. You will be given a follow up appointment to discuss the investigation findings and to talk about any treatment that might be offered.
What treatments might be offered? For women, if you are not ovulating (releasing eggs from the ovary) regularly and you have a BMI of between 19-35, you may be offered clomifene citrate (Clomid). Clomid stimulates eggs to develop in the ovaries and be released ready for fertilisation. It is started on day 2 of the menstrual cycle (day 1 is the day you start your period) and a tablet is taken once a day for 5 days. Ovulation usually occurs 5-12 days after the last Clomid tablet. A blood test will be performed in the second half of the cycle to measure the progesterone level. This will be carried out on day 21. This will enable us to see if you are ovulating. Clomid will not be prescribed for more than 6 months. If you have Polycystic Ovarian Syndrome (PCOS) metformin may also be used. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone
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(androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs. Metformin can help to reduce the amount of insulin in the body. When insulin levels are under control, regular ovulation may occur. Invitro Fertilisation (IVF) may be recommended if you have been diagnosed with unexplained infertility, your fallopian tubes are blocked, other techniques such as fertility drugs have not been successful. IVF is a treatment which involves the fertilisation of an egg outside the body and placing it back into the uterus (womb) ready for further development and growth.
Any Comments, Compliments, Concerns or Complaints If you have any other concerns please talk to your nurse, therapist or doctor. Our Patient Advice and Liaison Service (PALS) is available on 03033 306518 (Grimsby, Scunthorpe and Goole). You can also contact [email protected] As a Trust we value equality of access to our information and services, therefore alternative formats are available on request at [email protected]
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Date of Issue: December, 2020 Review Period: December, 2023 Author: Advanced Gynaecology Nurse Practitioner IFP-0795 v1.3
For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk