Here are some frequently asked questions.
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.
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.
It is thought that environmental pollutants are resulting in increasing sperm problems. As a result, we are seeing more men with:
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.
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
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 which patients are at a higher risk of ovarian hyperstimulation syndrome (OHSS). Patients with a low AMH do have lower pregnancy rates but the degree of this reduction is more age-related, with patients 39 years old and older having lower chance of pregnancy than patients with the same AMH who are less than 39 years old. Pregnancies have been reported in patients with very low, or barely detectable AMH levels but patients with a low AMH (less than 3.1 pmol/l) also have an increased risk of failed fertilisation across all age groups.
Sperm is 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 will advise on the options on a case by case basis. The semen analysis is the most important test, and the place to start.
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.
You can find out more on the SSR treatment page.
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 20C – 37C (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.
We have our own donor sperm bank and you can purchase what we have available at any one time. You can also obtain donor sperm from our preferred European sperm back. There is no waiting list for purchasing donor sperm, for more information about donor sperm, click here. The embryology team will advise as to how many straws or vials of sperm will be required for your treatment cycle.
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 3 to 5 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 3 to 5 rule is the best compromise therefore between concentration and motility.
The standard course of drugs for an antagonist cycle is 14 days. 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.
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.
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.
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.
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.
This will be discussed prior to the thaw with our embryologists, they will advise how many embryos to thaw for your individual circumstances.
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 90% 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.
We will send you a letter around the time of your annual storage recall. 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 further letters, attempt to contact you by phone/email and contact your last known GP. We will the contact you with an authorised discard date.
After your semen analysis your sperm will be frozen and thawed. This will show the survival rate of the sperm once thawed. You will then be contacted and informed whether you are initially suitable to be considered as a donor
Yes, the Human Fertilisation and Embryology Authority (HFEA) states that up to 10 families can be created from each donor. 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 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.
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), donations from someone known to the recipient patient (known egg donors) and donations from patients going through their own fertility treatment with no female fertility issues (egg sharers).
Apart from adhering to HFEA guidelines the clinic has few restrictions on who it will accept, the main one being an upper age limit of under 44 with your own eggs or under 55 using donor eggs. If after the initial consultation we do not feel that it would be in the best interests of your own health to proceed with IVF we will talk this through and provide full counselling and support to help you decide on the next step. For some unusual circumstances we may hold a case conference to discuss the ethics of proceeding to treatment. You will be advised if this applies to you.
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 services available, as well as a list of price examples, please visit our Prices section.
Generally, the presence of a hydrosalpinx means that the Fallopian tube is damaged. The fluid within a hydrosalpinx tends to leak back into the womb and reduces the chances of conception both naturally and after IVF treatment. Removal of the tube is recommended as this has been shown to almost double the chances of pregnancy.
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.
Shortly after egg retrieval altruistic donors will receive the £750 expenses payment for their donation cycle. After your donation your case will be reviewed and we will contact you to process the expenses.
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 but your reasoning would be discussed with the donor coordinator. Egg donors can donate all their eggs to one or two recipients per cycle so this will count as one or two families. 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 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 or sharer, 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.