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Treatments available for the subfertile couple

The GCRM has been set up to provide treatments which the NHS does not currently provide and also to provide conventional treatments for couples to whom NHS treatment is denied.

• IVF (In Vitro Fertilisation)
• ICSI (Intracytoplasmic Sperm Injection)
• Surgical Sperm Retrieval
• IUI (Intrauterine Insemination)
• Ovulation Induction and Intrauterine Insemination (OI/IUI)
• Donor Sperm (See Egg Share and Donor Programmes)
• Egg Donation (See Egg Share and Donor Programmes)
• Egg Sharing (See Egg Share and Donor Programmes)
• Blastocyst Culture
• Assisted Hatching
• Embryo Freezing
• Egg freezing (for Fertility Preservation or technical reasons)
• Sperm freezing

In vitro fertilisation (IVF)
IVF was developed for women where there is a Fallopian tube problem. It involves the woman having daily injections of follicle stimulating hormone (FSH or human menopausal gonadotrophins, HMG) for around 12 days, which stimulates eggs to grow. Most women give themselves the injections or get their partner to do it. The response to these injections is monitored, and at the appropriate time, the eggs (oocytes) are collected from the ovaries with a needle, in a procedure that usually takes around half an hour, during which you are sedated. The eggs are then mixed with your partner’s sperm, fertilsation occurs and embryos are produced. Usually one or two embryos are put back in the womb, two or three days later. For further information please click HERE.

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Intracytoplasmic Sperm Injection (ICSI)
ICSI was developed for couples where there is a problem with the numbers of sperm. The woman goes through the same process as for IVF but a single sperm is injected directly into the egg (rather than allowing them to try and fuse naturally). In these circumstances, ICSI improves the chances of fertilisation, and hence increases the chances of having embryos to put back in the womb. For further information please click HERE.

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Surgical Sperm Retrieval
If the tube which connects each testicle to the penis (the vas deferens) is blocked, sperm cannot get out with the ejaculate. However, sperm can be recovered directly from the testicle using techniques called MESA (micro-surgical sperm aspiration), TESA ( testicular sperm aspiration) or PESA ( percutaneous epididymal sperm aspiration) undertaken by a urologist. For further information please click HERE.

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Intrauterine insemination (IUI)
In cases of unexplained infertility, where the woman has been shown to be ovulating normally or where a couple might have difficulty having intercourse, the partner’s sperm is prepared and inseminated in to the womb at the time of ovulation without the need for stimulatory drugs.

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Ovulation induction and intrauterine insemination (OI/IUI)
The woman goes through the same injections as for IVF (but uses lower doses of FSH or HMG) and at the appropriate time her partner’s sperm is prepared and inseminated into the womb. Cycle for cycle, OI/IUI is not as successful as IVF but it is considerably less expensive and in cases of unexplained infertility, OI/IUI might be appropriate.

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Blastocyst culture
A blastocyst is an embryo that has been allowed to develop in the laboratory for five days or more after egg collection, during which time it grows into a bundle of cells. In standard IVF, embryos are allowed to develop for only two or three days in the laboratory before being transferred into the uterus. There is evidence supporting the use of blastocyst culture and transfer in certain patients. One such group are those where there are a number of similar embryos on day 2 or 3, and it is difficult to distinguish which are the best. Published figures show that of all embryos replaced in the uterus on day 2 or 3, only 15-20% actually implant and become a pregnancy, while in some patients, blastocysts are up to twice as likely to implant. There are a number of possible reasons for this improved success rate, but the most likely is that embryos which develop successfully to blastocyst stage are growing better than the others, and have a higher potential to implant.

So if it is so successful why is blastocyst transfer not used for everyone?

The problem is that many embryos do not survive five days in the laboratory, and if not carefully selected, some patients would not get an embryo transfer.

At the GCRM, as a guide, patients with at least 4 good quality embryos on day 3 will be considered suitable for blastocyst stage transfer. If the number of embryos is lower there will be no advantage to leaving the embryos outside the uterus, as we already know which embryos are best selected for transfer. It must be emphasised that this policy does not compromise the success rate of patients who do not proceed to the blastocyst stage - most IVF pregnancies still follow day 2 or 3 transfers.

The cost of IVF or ICSI treatment at the GCRM is fully inclusive of all costs associated with blastocyst culture and transfer.

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Assisted Hatching
The success of IVF is dependent on a whole series of events, one of the final steps being implantation. For implantation to occur, the embryo must escape from its outer coat (the zona pellucida) - this is known as "hatching". Once the embryo has hatched through the zona pellucida it can make physical contact with the lining of the womb (the endometrium) and implantation then begins. Failure of implantation may result from an inability of the embryo to hatch and in some women this may be why they aren’t getting pregnant, even with IVF. Assisted hatching is a physical or chemical treatment of the zona pellucida to try and improve implantation and at GCRM we use a laser as it is considered to be the safest and most accurate, and hence reliable, method. See Assisted Hatching patient information leaflet for further details.

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Embryo freezing
Embryo freezing is now a well established procedure. It allows us to freeze any good quality embryos that remain after embryo transfer. At GCRM embryos may be frozen at various stages of development; just after fertilisation (pronucleate stage), Day 2, 3 or Blastocyst. The decision to freeze and at what stage, will very much depend on which day the embryo transfer takes place and the number and quality of the embryos available.

Under certain circumstances a decision may be taken to freeze all embryos at the pronucleate stage. This is normally done to help prevent Ovarian Hyperstimulation Syndrome (OHSS, see IVF and ICSI Patient Information leaflet). At GCRM we have a very low incidence of OHSS so this course of action is rarely taken. If it is, the pronucleate embryos are thawed and replaced in a subsequent cycle.

The cost of IVF or ICSI treatment at the GCRM is fully inclusive of Embryo freezing and the first years storage.

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Sperm freezing
Like embryo freezing, sperm freezing is now well established. There are a variety of reasons why sperm may need to be stored including:

• Prior to chemo or radiotherapy
• Prior to vasectomy
• Prior to any surgery that may result in impaired fertility

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For further information on Embryo/Sperm freezing or any of the other treatment options above please Contact GCRM.

The Risks of Infertility Treatment

At the GCRM we take a responsible attitude to the risks associated with infertility treatment and wish to minimise these risks for your safety and that of resulting pregnancies.
The two most common problems are ovarian hyperstimulation syndrome and multiple pregnancy.

Ovarian Hyperstimulation Syndrome (OHSS)
This is due to the ovaries being over-stimulated by the infertility drugs and we minimise this by encouraging all women to have an initial "Ovarian assessment". This allows us to tailor the treatment cycle to the individual woman making the stimulation process more precise and safer.

Multiple pregnancy
It comes as a surprise to many to learn that twin pregnancies are a problem.
Multiple pregnancies following IVF or ICSI are the most important problem patients face. The stark facts show increases in maternal problems through and after pregnancy, and also in increased problems for the children. The main problems are miscarriage, hypertension, premature labour and caesarean section or delivery with forceps. The risks to the children and their development are also much increased.
We strongly advice women who are at particular risk of multiple pregnancy to think in terms of having one embryo replaced at a time (eSET; elective single embryo transfer).

Identification of those at risk
The main problem is one for younger women who, on average, have more embryos of better quality than older women.
At GCRM, women under 33 years, with an AMH of more than 5 pmol/L and with spare embryos available, show a twin pregnancy rate of 30% after a two embryo transfer. We strongly recommend patients in this category to have elective single embryo transfer.
Correspondingly, in woman less than forty years of age we aim to replace no more than two embryos. You will be advised and supported by all staff through your decision making. More information can be seen at www.oneatatime.org.uk