The Patient Journey
This information has been produced in order to guide you through ‘the patient journey’ once you have decided to proceed with treatment. GCRM is a team of professionals, and you will be managed according to your needs. This means that through your treatment, you may see different members of staff at different times. We pride ourselves on our multi-disciplinary team. All our staff are trained to the highest standards and are involved in regular meetings about your care.
We believe it is more important that you see the appropriate member of staff at the appropriate time, rather than organising your treatment around the availability of a particular doctor. Of course if you wish to be seen by a female doctor at any point during your treatment, we will do our best to accommodate you.
Consents appointment
After your initial consultation and assuming you have decided to proceed with treatment, you will make an appointment for your 'consents appointment'. At this visit we ensure that we have all the results of the necessary investigations and we go through the various consent forms. There are some consent forms that you must sign and others which are optional but we’ll explain why they might be valuable to you.
Different treatment protocols
Treatment can be complicated and you must never feel that any question is too trivial. If you ever have any queries or are unclear about what you should be doing, please do not hesitate to ask or phone us to get an answer. Remember, you won’t be the first person to have asked the question (and it's better to ask a question than make a critical mistake!) - so please ask.
Every woman is different and at the GCRM we aim to tailor treatment to the individual to maximise their chances of success. The type of treatment, the dose of drugs and the days of stimulation will vary from woman to woman and different treatment protocols will be appropriate for different women.
The principle of treatment is to modify the body’s natural controlling mechanisms. These are governed by the pituitary gland in your brain controlling the 2 separate processes of follicular growth and the act of ovulation.
With the GnRH-agonist protocol; you get an injection or a nasal spray on Day 21 of your cycle (Day 1 is the first day of your period) and this switches off the pituitary gland. You will have a period 7-10 days later and you contact us when your period starts. We will perform a vaginal ultrasound scan and take a blood test for oestrogen levels and will advise on when to start your stimulation drugs.
With the GnRH-antagonist protocol; you contact us when your period starts. We will perform a vaginal ultrasound scan and take a blood test for oestrogen levels and will advise on when to start your stimulation drugs. We then perform further scans and blood tests. If there are signs of follicle development, you continue with the stimulation injections and then start the daily GnRH-antagonist injections.
The stimulation (fertility) drugs
These drugs encourage growth of the follicles (the fluid filled structures containing eggs) in the ovary. You will have a diary detailing the type and dose of fertility drug but if you have any queries, please do ask a member of staff for clarification. You give yourself the injections of the drug every day and we will tell you when to come back for your next ultrasound scan and blood test. The average number of days to be on stimulation injections is 10-12 days but some women respond faster whilst others take a little longer.
HCG injection
Once there are suitable numbers of good-sized follicles, a final hormone injection (HCG) will be given to induce the final maturation processes in the eggs and the follicles. This injection is timed for 36-40 hours before planned egg collection. We will tell you exactly when the HCG injection should be given.
The timing of this injection is critical, and it must be given at the time specified.
Oocyte (egg) collection
You must fast before the procedure as sedation drugs are used; so please do not eat or drink anything after 12 midnight from the night before. On the morning of the egg collection the anaesthetist will take a history of your general health and discuss the procedure with you.
An intravenous cannula (a drip) will be placed in your arm through which your sedation will be given. Please refer to the Conscious Sedation page for further information.
Once you are sedated you have a vaginal ultrasound scan, as before, but this time a fine needle is passed down a specialised guide attached to the ultrasound probe. The tip of the needle passes through the top of the vagina into the ovary on each side and the follicular fluid is aspirated (sucked out). The fluid is collected in a test tube and the contents checked to see if there is an egg present. Once all the follicles have been aspirated we will let you know how many eggs have been collected and you return to your recovery room.
Once you have recovered from the sedation (usually in 1-3 hours) you can go home. You are not allowed to drive for 24 hrs after the sedation and whether you intend travelling home by public transport or by car, you are best to make arrangements to have someone escort you home.
The day after egg collection
The following day one of our embryologists will call you to tell you how many eggs have fertilised and give you an idea of when to come back for your embryo transfer. The transfer will be arranged for between 2 and 5 days after your egg collection.
Embryo transfer
This is a very simple procedure and similar to having a cervical smear taken so it does not require any sedation or anaesthetic. We have developed policies on the most appropriate number of embryos to transfer. In women over forty the transfer of three embryos may be considered. In women less than forty years of age we aim to replace no more than two embryos and occasionally a single embryo transfer may be recommended. The reason for this is the consequences of multiple pregnancies have been shown to carry high risks to babies and mothers. These transfer policies generally strike the right balance between acceptable pregnancy rates and low multiple pregnancy. Depending on the quality of the remaining embryos, these can be frozen and used at a later date, but it is important to appreciate that some of the frozen embryos may not survive the thawing process.
After the embryo transfer
After embryo transfer, you will require hormone support to encourage successful implantation. We generally use vaginal progesterone or an additional HCG injection or a nasal spray. The effect of this support means that you may not have any bleeding, (even if you are not pregnant), so we do require a urine sample for a pregnancy test two weeks later to confirm your outcome. If the pregnancy test is negative we will give you the opportunity to arrange to come back for a review appointment. You will be able to discuss the treatment and talk through your options including any modifications which may improve the outcome in a subsequent treatment cycle.
If the test is positive, and events are uncomplicated, we will arrange for a scan in approximately 3 weeks.
Possible side effects
Common side effects of the GnRH agonists are hot flushes, headaches and mood swings which are due to low oestrogen levels. However, they subside once the oestrogen levels in your blood build up with the fertility drugs.
Ovarian Hyperstimulation Syndrome
At the GCRM we pride ourselves in individualised treatment cycles which minimises the risk of Ovarian Hyperstimulation Syndrome (OHSS). However, despite careful monitoring, a small number of women may over respond, leading to OHSS. OHSS can vary in its severity:
In a mild form - the ovaries are slightly enlarged and you may feel abdominal ‘cramps'. If so, please notify nursing staff when attending the unit.
In the severest form - the ovaries are very enlarged and fluid can gather in the abdominal cavity causing discomfort or pain. Rarely vomiting, diarrhoea, abdominal swelling and breathlessness may occur and the patient may feel weak and faint and notice a reduction in urine output. Admission to hospital may be required for observation and appropriate treatment. This rare complication requires urgent attention. If you feel these symptoms occurring you or your doctor should contact the GCRM or the Southern General Hospital (0141-201-1100 and ask for the on call gynaecology registrar).
Pregnancy scan
If you do have a positive pregnancy test we will arrange for you to return for a scan about three weeks later to confirm that the pregnancy is continuing and how many embryos have implanted.
Further information
Each treatment cycle is reviewed, regardless of outcome, and a suggested plan made for you. If you have not conceived after one stimulated cycle and you have embryos frozen, we would encourage you to have these replaced before beginning another stimulated cycle.
As a licensed centre we are required to determine the outcome of all pregnancies conceived with assisted conception. You will be given a form to return to us detailing the outcome of the pregnancy and we would be grateful if you could complete this.
Sadly, miscarriage or abnormalities can occur as with a natural conception and statistics show that women conceiving over the age of 35 can have increased problems during pregnancy. However, this is no greater for IVF patients when compared to a similar population of women conceiving without medical intervention.
Counselling
Some people feel they would like to see a counsellor and some don’t. We feel that counselling is an integral part of the service we offer. Please refer to Counselling & Support for further information.
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