You have been referred into Infertility services as you have been trying to conceive for 12 months or more without success having sexual intercourse 2-3 times a week, or you have had 6 cycles of artificial insemination (with partner or donor sperm).
To fulfil criteria for a referral to IVF/IUI whereby all investigations have been carried out in section 1.3.2 of the Blackpool CCG and the NHS Fylde and Wyre CCG Infertility policy.
The person has failed to conceive after 2 years of regular sexual intercourse 2-3 times per week or 12 cycles of self-funded artificial insemination has been attempted, 6 of which are by intrauterine insemination undertaken at a Human Fertilisation and Embryology Authority (HFEA) registered clinic.
We treat you here at Blackpool as a couple. Therefore, it would be advantageous if you both attended appointments. This also allows you to support each other through this difficult time.
For those who are seeking sperm or egg donation. It is advisable that you also bring someone to the appointment.
We strive to get you seen in a timely manner. However, this process requires diligence as there are lots of tests and investigations. Please be prepared for this and explain to your employers that you will require some time off at the initial stages to allow you to attend for investigations.
Amenorrhea – no periods Azoospermia – no sperm seen
Body Mass Index (BMI) – is a measure that uses your height and weight to work out if your weight is healthy
Clinical commissioning groups (CCGs) – CCGs are responsible for about 60% of the NHS budget. They commission most secondary care services, and play a part in the commissioning of GP services
Circumcision – The foreskin is removed just behind the head of the penis using a scalpel or surgical scissors
Dysmenorrhea – painful periods Endometriosis – a condition resulting from the appearance of endometrial tissue outside the uterus
Fibroids – a benign tumour of muscular and fibrous tissues, typically developing in the wall of the uterus Follicle Stimulating
Hormone (FSH) – promotes the formation of ovum
General Anaesthetic – medicines are used to send you to sleep, so you’re unaware of a surgical procedure
Hysterosalpingo-contrast-sonography (HyCoSy) – A speculum is gently inserted into the vagina then a catheter (narrow plastic tube) is introduced through the cervix (neck of the womb). A tiny balloon on the end of the catheter is inflated to keep the catheter in position. An internal ultrasound scan is then performed to watch as a small amount of water is passed through the catheter into the uterus. The water shows up the lining of the uterus. A special fluid that is seen clearly on ultrasound is then passed through the catheter to show up the fallopian tubes. This fluid is easily processed and absorbed by the body after the procedure. The test takes 15 to 20 minutes.
Hyperthyroidism – high thyroid hormone production can impact fertility by causing irregular menstrual cycles, increase the risk of miscarriage or cause premature birth and affect sperm quality causing reduction in sperm count.
Hypothyroidism – low thyroid hormone production can impact fertility by causing irregular menstrual cycles, disrupt the release of an egg from the ovaries and increase the risk of miscarriage or premature birth.
Gravida – Pregnancy
Hirsutism – excess hair growth
Human Fertilisation and Embryology Authority (HFEA) – oversees the use of gametes and embryos in fertility treatment and research. It licenses fertility clinics and centres carrying out in vitro fertilisation (IVF), other assisted conception procedures and human embryo research.
Hydrocephalus – a build up of fluid on the brain.
Intrauterine Insemination (IUI) – is the placing of sperm into a woman’s uterus when she is ovulating.
Menorrhagia – abnormal heavy menstrual bleeding.
Morphology – refers to the size, shape and appearance of a man’s sperm.
Motility – the ability of sperm to move efficiently.
Laparoscopy and Dye – The dye test is used to show if your fallopian tubes are blocked and the laparoscopy finds out if you have any gynaecological conditions that affect fertility such as polycystic ovaries, endometriosis, adhesions (scar tissue from previous surgery), ovarian cysts, pelvic infection and fibroids.
Luteinizing hormone (LH) – helps control the menstrual cycle. It also triggers the release of an egg from the ovary.
Menstrual Cycle – is counted from the first day of one period to the first day of the next.
National Institute for Health and Care Excellence (NICE) – provides national guidance and advice to improve health and social care services, using evidence-based recommendations it is driven and developed by independent committees to ascertain equality and diversity, fairness and equal opportunities where possible to patient care.
Oligospermia – low sperm count
Ovum – a mature female reproductive cell
Ovulating – Ovulation is the process in which a mature egg is released from the ovary.
Parity – live child.
Polycystic Ovarian Syndrome (PCOS) – polycystic ovaries contain many large follicles. They present with irregular periods or amenorrhea, additional high hormone levels or hirsutism.
Progesterone – a hormone produced mainly in the ovaries by the corpus luteum. Within a certain range during the luteal phase, it possibly means you are ovulating.
Prolactin – a blood test that measures a hormone level in the pituitary gland.
Seminal analysis – evaluates certain characteristics of a male’s semen.
Speculum – a plastic medical device to examine the female vagina.
Spina bifida – where the spine and the spinal cord does not develop properly in the womb. Can cause weakness, paralysis of the legs, bowel incontinence, urinary incontinence, learning difficulties and hydrocephalus.
Thyroid Stimulating Hormone (TSH) – a blood test that measures the thyroid hormone produced in the pituitary gland.
Treatment Unit – is the currency used to describe the amount of assisted conception treatment to which a patient is eligible.
A treatment unit is defined as EITHER: A – Up to 12 separate attempts at IUI, each in a different menstrual cycle;
OR
B – One programme of IVF treatment comprising:
Ovarian Stimulation
Induction of ovulation
Harvesting of resultant eggs
Harvesting of semen
Fertilisation
Storage of eggs/ semen/ embryos
Triple swabs – this consists of 3 samples being obtained via a speculum examination in the vagina to check for: infection, chlamydia and gonorrhoea.
Urinary Tract Infections – infections of the urine.
World Health Organisation (WHO) – sets standards for disease control, health care, and medicines, conducts education and research programmes also publishes scientific papers and reports.
Unexplained Infertility – 30% of infertile couples worldwide are diagnosed with unexplained infertility and the problem is defined as the lack of an obvious cause for a couple’s infertility.
Urinary tract Infections (UTI’s) – Males; bacteria can spread across the prostate gland and other reproductive structures which may result in decreased sperm and motility.
-Females; can effect uterus bladder and kidneys, causing pelvic inflammation which can result in scarring to the fallopian tubes
You have been to the GP and they have completed a seminal analysis test, triple swabs and blood tests.
All results will be reviewed at your first appointment along with the completed health questionnaire within this pack. If you meet the criteria from the NHS Blackpool CCG and NHS Fylde and Wyre CCG; Policy for Assisted Conception Services, we can then proceed and request a hycosy or laparoscopy and dye.
Once all the results are collated, we will know if the reason is the biological male, biological female or unexplained infertility.
At this point, we can either commence clomiphene or refer to IVF/IUI if you meet the criteria.
All investigations should be completed within 6 months.
If you have not already done so please commence folic acid. Ideally this should be commenced 3 months before conception at a dose of 400 micrograms. Evidence has shown that it can reduce neural tube defects such as spina bifida, anencephaly and encephalocele.
Criteria for one treatment unit
• The patient, and their partner in the case of couples, must not have a living biological or adopted child from their current or any previous relationship.
• Neither partner has previously had a treatment unit or part of a treatment unit of assisted conception irrespective of the source of funding.
• The female partner is between 18 years and 42 years of age. Treatment must commence before the female partners 43rd birthday.
• Additionally, if the funding package includes harvesting of eggs from a donor, then the donor has not yet reached the age of 40 years and has no evidence of infertility.
• Neither partner has been previously sterilised.
• The female partner seeking to become pregnant has a body mass index in the range 19-30.
• The female partner is a non-smoker, and commits to remain so throughout the treatment unit and until the completion of any resulting pregnancy; For the purposes of this policy the use of an e-cigarette is considered equivalent to non-smoking status.
• The other partner (when applicable), is a non-smoker, and commits to remain so throughout the treatment unit. For the purposes of this policy the use of an e-cigarette is considered equivalent to non-smoking status.
• If the female partner is aged 40-42, a treatment unit will be offered provided the following two additional criteria are fulfilled:
– There is no evidence of low ovarian reserve
– There has been a discussion of the additional implications of pregnancy and IVF at this age.
Criteria for Clomiphene
• The biological female must have a BMI between 19 and 35.
• Biochemistry evidence of no ovulation or amenorrhea for 6 months or more
• LH/FSH/Prolactin within range
• Age 42 or below with normal ovarian reserve
• Semen analysis is within WHO limits. However, it will be assessed on an individual basis as an abnormal analysis does not always mean that clomiphene does not work.
• Bilateral tubal patency with spill evident on Hycosy or Laparoscopy and Dye.
At present, there is not a none smoking requirement for clomiphene. However, smoking can cause infertility and premature babies, so it is advisable that you stop smoking as soon as you plan on starting to conceive.
Weight management:
The main reason patients cannot continue in secondary care is weight management. This is because you need a BMI of 35 or below for Clomiphene and a BMI of 30 or below for IVF.
We will ask your GP to refer you to a weight management programme to help you achieve your weight loss. This not only improves your health and wellbeing but also may regulate naturally your ovulation and menses.
PCOS:
PCOS cannot be managed and treated in this clinic. It is only for infertility and not PCOS management. Infertility and PCOS do cross over. However, this clinic is primary/secondary infertility only.
Smoking:
The minimal requirement to stop smoking is 6 months. This is applicable to both biological male and female patients for an IVF referral to be accepted. Vaping is classed as a non-smoking aid. You will be referred to your GP if this has not been met.
Please refer to the document titled ‘Guidance on implementing the overseas visitor charging regulations’.
There are numerous different variations of visa applications to mention here. If you read the document provided you can look to see if you will be chargeable or not for your fertility treatment
Prior to your appointment, the overseas team will contact you and you must produce your papers if you have not already done so, and they will inform you if you are chargeable or not. This includes charges for the 1st consultation. This is not free, and you will be charged for this service.
If you are in doubt, please contact the team on 01253 951164 and they will be able to help you.
Full CCG guidance: https://www.fyldecoastccgs.nhs.uk/?wpfb_dl=2728&no_preview=1
NHS infertility information: https://www.nhs.uk/conditions/infertility/diagnosis/
National Institute for Health and Clinical Excellence Clomid patient information: https://www.evidence.nhs.uk/search?q=clomid
Information for laparoscopy and dye: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC194096/
Laparoscopy recovery patient information: https://www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/recovering-well/ laparoscopy-for-print.pdf
Semen analysis normal range: https://www.semanticscholar.org/paper/Semen-assessment.-Centola/03c0702ade30529874eec1aa92f d1614a90179f2
Facebook Online Support Group: Blackpool Teaching Hospitals Online Infertility Support Group
Counselling contact: https://lancashirewomen.org/
Guidance on implementing the overseas visitor charging regulations: Guidance on implementing the overseas visitor charging regulations (publishing.service.gov.uk)
Human Fertilisation and Embryology Authority (HFEA): HFEA: UK fertility regulator | Human Fertilisation and Embryology Authority
