An introduction to IVF at Homerton Hospital Offering you the very best clinical service in friendly, modern surroundings Homerton Fertility Centre
Welcome to the Homerton Fertility Centre The Homerton Fertility Centre opened its doors in 1995 and is accredited by the Human Fertilisation and Embryo Authority (HFEA). We moved to modern purpose-built state of the art facilities at Homerton Hospital in 2008. This brochure introduces you to our Centre and to members of our team and allows you to gain an idea of the assisted conception techniques on offer here. We hope it will help you gain an understanding of what we can do for you and enable you to be better informed on some of the complex issues that face any couple starting fertility treatment before you decide what you want to do. About Homerton Hospital Homerton University Hospital is a modern, friendly hospital and was one of the first NHS foundation hospitals in the country. Based in the multicultural east London Borough of Hackney, we provide general and emergency services to the local communities of Hackney and the City of London. We also provide specialist care in Obstetrics and Gynaecology as well as Neonatology for patients across east London, Essex and beyond. A mulit million pound state of the art mother and baby unit is being built at the hospital complete with specialist services for the care of the unborn and neonatal services for premature babies.
One in six couples find it hard to get pregnant in spite of regular unprotected intercourse whilst trying for over a year. We are here to help and guide you to what we all hope will be a successful outcome. We are a team of medical, nursing and scientific experts dedicated to giving a comprehensive and caring fertility service. The treatment services we offer are of the highest standards and our results compare favourably with the national figures (hyperlink to our results please) for In Vitro Fertilisation (IVF) published by the Human Fertilisation and Embryology Authority (HFEA), with whom we are licensed to practice a variety of assisted conception techniques. www.hfea.gov.uk We regularly review and update our practice by research and audit with the aim of improving our success rates. However, we also feel that it is important to be honest and realistic with our patients and we acknowledge that, sadly, we will not be able to achieve a pregnancy for all couples that undergo treatment with us. We hope that, whatever the outcome, the experience will be a positive one and we will try to give you as much support as possible both during and after your treatment. We recognise that every couple is different and we believe it is essential that couples with a fertility problem have rapid access to expert advice, given in a sympathetic manner, taking individual factors for each couple into account. We have detailed information sheets about specific types of treatment. If you would like one or have any questions or concerns, please speak to a member of our team or explore our website. Finding us The Homerton Fertility Centre can be found on the: 1st Floor, above the main entrance of Homerton Hospital, Homerton Row, Hackney, London E9 6SR Tel: 0208 5107660 We are open Monday to Friday, 8.30am to 4.30pm. Saturday - Strictly by appointments only We are usually closed during the Xmas and New Year periods (please ask staff members about the dates). There is always a doctor or a nurse from the Centre on call for emergencies for couples going through active treatment procedures. You will be told how to contact us if that is the case. We welcome your comments on this brochure and any part of our service. Please speak to a member of the team or email fertilityunit@homerton.nhs.uk Homerton Fertility Centre 1
Our team Nurses Our team of nurses will plan your treatment schedule and teach you about any medications used in your treatment. The nurses perform ultrasound scans, blood tests and assist in egg collection and embryo transfer. We are an experienced team of doctors, nurses, embryologists and counsellors supported by administrative staff. We work together to give a comprehensive service for the investigation and treatment of couples with infertility. Support team A member of our support team, the centre receptionist, will probably be the first person you meet when you come to see us. Please speak to a member of the team if you have a question about your referral, our waiting lists, or the funding of your treatment. Doctors You will meet a doctor at your first visit with us. Our team of doctors will oversee all aspects of your treatment in the centre and perform ultrasound scans, egg collection and embryo transfer. Embryologists The embryologists are responsible for your eggs, sperm and embryos whilst they are in the laboratory. After egg collection, they prepare the eggs and sperm for fertilisation and look after the embryos. They also perform sperm injection for Intracytoplasmic Sperm Injection (ICSI), assisted hatching and will freeze sperm and embryos for later use in treatment where appropriate. Counsellors We think counseling is an integral part of your treatment and encourage all couples to see a counsellor. All counselling is confidential and free of charge. Counselling gives support from a trained professional who understands what is involved in your treatment and offers you the time to talk over your options or concerns. Most people find that having someone to discuss this with makes all the difference between feeling stressed and worried, to feeling more able to cope. 2 Homerton Fertility Centre
Some commonly asked questions about IVF What is fertility treatment? Assisted conception is a term used to describe the methods available to help couples to become pregnant when they are having difficulty conceiving. It is also often called fertility treatment. This brochure has information about the treatments available at our Centre and who might benefit from them. We understand that many of the words used in this booklet might be new to you. There is a glossary at the back to explain words you might not know. Why do some couples need fertility treatments? Knowing how a pregnancy occurs naturally can help us understand the reasons why assisted conception is sometimes needed. Please see the diagram on page below. Each month, an egg develops in one of the ovaries in a small sac of fluid called a follicle. The egg is released from the ovary and passes down one of the fallopian tubes, which are attached to the uterus (womb). For a pregnancy to occur, sperm, which has been deposited in the vagina during intercourse, has to swim towards the egg in the fallopian tube. This is where fertilisation normally occurs. The fertilised egg (embryo) begins to develop as it travels through the fallopian tube towards the uterus. After about five days, the embryo hatches out of its outer coating and buries itself (implants) in the thick lining of the uterus where it begins to grow. Rarely, an embryo implants in the fallopian tube. This is called an ectopic pregnancy. The need for assisted conception One in six couples take longer than one year of regular, unprotected sexual intercourse to become pregnant. Assisted conception might be needed if: the woman s ovaries do not produce an egg each month; there is a blockage in the fallopian tubes; or there are problems with the sperm. Both partners might have a reason for a delay in conception. In about one in three couples we do not find a reason for the delay. There are treatments available for all of these circumstances and we will talk to you about a suitable option for you. Site of fertilisation Sperm Egg Uterus Fallopian tube Implantation of embryo Egg released from ovary Ovary Cervix Developing follicles with eggs inside Sperm deposited in vagina Vagina Homerton Fertility Centre 3
How can we improve our chances of conceiving? There are a number of positive things you can do to improve your chances of conceiving. Weight (female partner) If you are overweight you might not respond as well to the medication used to stimulate your ovaries and as a result produce fewer eggs. It is more difficult to obtain a clear, scan picture during egg collection when you are overweight. The medication we give you for pain relief and sedation during this procedure can slow your rate of breathing and this can cause complications if you are overweight. If you are excessively overweight the risks of collecting eggs using an anaesthetic are too great. If you do become pregnant, the chance of miscarriage might be higher and there can be more complications in pregnancy, in particular with high blood pressure and sugar tolerance (gestational diabetes). Maximum Weight at which recommended we refuse Height weight treatment feet metres pounds kg pounds kg 4 11 1.50 10-7 68 12-5 79 5 0 1.52 11-0 70 12-10 81 5 1 1.55 11-3 72 13-3 84 5 2 1.57 11-6 74 13-9 87 5 3 1.60 12-1 77 14-2 90 5 4 1.62 12-4 79 14-8 93 5 5 1.65 12-8 82 15-0 95 5 6 1.67 13-2 84 15-6 98 5 7 1.70 13-5 86 15-13 101 5 8 1.72 13-10 89 16-6 104 5 9 1.75 14-4 92 16-12 107 5 10 1.77 14-8 94 17-5 110 6 0 1.82 15-6 99 17-12 113 For example, if you are 5 6 and weigh more than 13 stone 2 pounds (84kg), we recommend you lose weight before starting treatment. If you are 5 6 and weigh more than 15 stone 6 pounds (98kg) we cannot offer you treatment unless you lose weight. Table 1 shows the maximum recommended weight for your height. If you exceed this weight we recommend that you lose weight before starting treatment. We can refer you to a dietitian or you can speak to your GP about weight loss programme. Group weight loss programme have been shown to be more effective than individual dieting. Table 1 also shows the weight at which we will refuse treatment. For example, if you are 5 6 and weigh more than 13 stone 2 pounds (84kg), we recommend you lose weight before starting treatment. If you are 5 6 and weigh more than 15 stone 6 pounds (98kg) we cannot offer you treatment unless you lose weight. Smoking and Cannabis We recommend if either of you smoke cigarettes or cannabis, to stop. Smoking has been shown to reduce the chances of conceiving naturally and lowers the success rates of IVF. Cannabis also seriously affects sperm quality and reduces the chance of fertilisation. If you want help to try and stop smoking, please speak to your GP. You might also want to call the NHS Smoking Helpline on 0800 169 0169. Alcohol Excessive intake of alcohol, especially binge drinking, can decrease sperm production and the number of moving sperm. Sperm take 72 days to form so the effects of damage take a long time to reverse. It is recommended that you drink less than two units of alcohol per day. It is also recommended that the female partner drinks no more than six units of alcohol per week. Folic Acid We recommend the female partner takes 400 micrograms of folic acid each day, available over the counter in a pharmacy. Folic acid is a vitamin, which has been shown to reduce the risk of abnormalities of the brain and spinal cord (anencephaly and spina bifida) in an unborn baby. It has no side effects and is safe to take during pregnancy. Folic acid should be started about three months prior to commencing efforts to get pregnant and continued to the 12th week of pregnancy. 4 Homerton Fertility Centre
First steps Your journey with us... referral via GP or hospital appointment with fertility specialist investigations arranged for future date follow up appointment to discuss test results agree treatment plan IVF treatment IUI treatment no treatment at present NHS waiting list self funded further investigations discharge specialist nurse appointment to commence treatments How can I be referred to the fertility centre? We ask that you send us a referral letter from your GP or gynaecologist detailing all past investigations and treatments. If you are referred to us there will be no charge for your appointments as these are covered by the NHS. Once we have received the referral we will contact you to confirm your appointment. We are happy to see any patient for an initial consultation. We normally do not encourage and advice women over the age of 45 years using their own eggs and women over the age of 49 using donor eggs for fertility treatments. However we believe, each case4 should be consulted on its merits. We offer the same opportunities for investigations and treatments to single women and same-sex couples. We expect all couples (including heterosexual couples) to be in a stable relationship of at least one year before seeking treatment. We follow the Human Fertilisation and Embryo Authority s (HFEA) code of practice about assessing the welfare of the unborn child; we will ask you to fill out a questionnaire and will undertake a detailed medical and social history to ensure that we fulfil this legal obligation. What will happen at my first consultation? Your first consultation will be with a doctor and will last about 30 minutes. A medical, social and gynaecological history will be taken. By the end of this consultation you will have discussed a plan of investigations and possible treatment options. It is unlikely that you will need to repeat investigations performed recently if the results are available to our centre. If you are seeking treatment as a couple we prefer to see both of you at your first consultation. A follow-up appointment with the doctor may be required to receive your test results. Homerton Fertility Centre 5
What investigations may I need to have? Women You may be asked to have all or some of the following investigations: an ultrasound scan of the pelvis, uterus (womb) and ovaries hormone blood tests (day 2-5 of menstrual cycle) an x-ray to show whether the fallopian tubes are open or blocked (hysterosalpingogram/hsg) keyhole surgery that inserts dye into the uterus to show any blockages (laparoscopy and dye test) hysteroscopy (where a small telescope is placed in the womb to check that it is normal) urine test for Chlamydia screening Men All male partners attending the centre for infertility investigations will be required to provide a semen sample for assessment. This will need to happen before any treatment plan can be arranged by appointment only. Blood tests for Infection Screening Fertility treatment requires screening for patients and their partners for Human Immuno-deficiency Virus (HIV), hepatitis B and C and Syphillis. We know that being tested for HIV and Hepatitis is stressful. We will support you during this process and you will also be offered the opportunity to have independent, confidential counselling at any stage. Reproductive surgery Some women will receive surgery to treat fibroids, endometriosis or abnormalities inside the womb, before assisted conception treatment begins. This is also sometimes required for women who have blocked tubes. This can be performed at Homerton with the doctors that you see. Nurse appointments Before starting any treatment it is usual for you to have an appointment with a fertility nurse who will explain the treatment process. The semen sample has to be produced by masturbation after two or three days of abstinence from ejaculation. It should not ideally be before or after this time frame. If you feel that producing a sample may be a problem, please call the centre to discuss further. 6 Homerton Fertility Centre
Our range of fertility treatments We offer a range of fertility treatments to ensure that we can find the most suitable and appropriate option for you. Ovulation induction The use of tablets or injections to stimulate your ovaries to produce eggs. This is monitored carefully by ultrasound during the treatment cycle to pinpoint ovulation and allows the correct timing of sexual intercourse or intrauterine insemination. Intra-uterine insemination (IUI) using partner s sperm Your partner will need to produce a sperm sample on the day you are ovulating (which can be pinpointed through ultrasound scans and urine tests). The sperm is assessed and prepared in a special solution, and is then passed through the cervix (neck of womb) and placed into the uterus (womb), using a fine soft catheter. This treatment is useful for: ovulation problems mild endometriosis some cases of unexplained infertility. Intra-uterine insemination (IUI) using sperm donor Sperm from a donor is prepared and passed through the cervix and placed into the uterus using a fine soft catheter on the day you may be ovulating. This form of treatment is used for single women, women in same sex relationship and women whose partners are not producing sperms. In-vitro fertilisation (IVF) In a woman s normal menstrual cycle one egg will usually develop to maturity in the ovary, within a sac of fluid called a follicle. As the egg matures the follicle becomes larger, reaching 18-21mm by the middle of the cycle. The follicle then ruptures, releasing the egg (this is called ovulation). In order to perform IVF, the ovaries are first stimulated with drugs to grow more eggs, hopefully six to ten eggs. The eggs are then collected from each follicle just before ovulation begins. The egg collection is performed through the vagina under ultrasound control. This procedure is performed under conscious sedation. IVF is where the eggs and sperm (from the male partner or donor) are collected and mixed outside the woman s body in the laboratory. If fertilised, the eggs develop into embryos and we aim to transfer one or two best embryos back into the uterus (womb) after three to five days (blastocyst). Any remaining goodquality embryos can be frozen and stored for future use with your consent, according to medical advice (see embryo freezing). Intra-cytoplasmic sperm injection (ICSI) ICSI is offered when there are problems with the sperm that makes it difficult to fertilise naturally or through traditional IVF. It is a similar process to IVF, whereby the woman s ovaries are stimulated and the eggs are collected. However, to achieve fertilisation, the eggs - once collected - are treated with an enzyme to remove the surrounding cells and a single sperm is taken into a fine glass needle and injected directly into the egg. If fertilised, the eggs develop into embryos and we aim to transfer the two best embryos back into the uterus (womb) after three to five days (blastocyst). Homerton Fertility Centre 7
ICSI has similar success rates compared with conventional IVF. Research so far has shown that there are no statistical increase in birth defect rates with ICSI when compared to IVF or natural conception. Embryo freezing Following IVF treatment, one or two embryos (very rarely three) can be replaced into the woman s uterus. If the quality of the remaining embryos is good they can be frozen for embryo transfer at a later date. Embryos can be stored for a maximum of ten years. There is a yearly storage fee to help us cover administrative costs. Sperm freezing Sperm can be frozen as a backup in cases where your partner is anxious or unable to produce a semen sample on the day of intended treatment. Consent is required for this and all other procedures involving use or storage of sperm. A small cost is incurred for this additional service in most cases. Surgical sperm recovery Sperm can sometimes be removed surgically from the testes when men have been found to be azoospermic (no sperm in the semen). We can refer your partner to our urology department for a surgical sperm retrieval procedure, under local or sometimes general anaesthesia. One of our embryologists would be present during this process. If any sperm are found these are frozen for future use. The patient can then proceed with an ICSI cycle only. Egg donation Some women are unable to produce their own eggs, for example their ovaries have not developed properly as a result of a gentic disorder or there has been ovarian failure caused by premature menopause, surgery or cancer treatments. Others may not wish to use their own eggs for medical reasons. An egg donor should be, ideally, between 21 and 35 years of age. She must be fit and healthy, and ideally should have completed her family. Donating eggs is a voluntary process and no payment is made to the egg donor, apart from travel expenses for hospital visits. To donate eggs the woman has to go through the process of ovarian stimulation for IVF and have an egg collection performed. Surrogacy A surrogacy arrangement is one where one woman (the surrogate mother) agrees to bear a child for a married couple (the intended parents). Surrogacy can be used for women who are unable to carry a baby themselves. This may be due to hysterectomy, pelvic disorder, or where a pregancy would be a serious risk to health. Surrogacy can also provide a solution for women who suffer repeated miscarriage or late pregnancy loss. If you are considering surrogacy please speak to a member of staff for more information about this. We provide counselling prior to embarking on any surrogacy arrangement. Embryo donation For a variety of reasons some couples are unable to produce their own genetic sperm or eggs. In such cases both donor sperm and donor eggs can be used to produce an embryo. On rare occassions we have frozen embryos available for donation. This can happen when couples have had embryos frozen during IVF treatment and then decide to donate some or all of their embryos to another couple. 8 Homerton Fertility Centre
Further information... Homerton Fertility Centre
London Overground railway stations Pedestrian walkway Bus stops One-way street Please note that there is limited pay and display parking in streets around the hospital. After 5pm and at weekends on site parking is available. Homerton University Hospital, Homerton Row, London E9 6SR. Telephone: 020 8510 5000 www.homerton.nhs.uk