Most assisted pregnancies follow a carefully structured fertility treatment journey, as shown in the steps below.
Step 1 – Consultation
Your initial consultation at the Herts & Essex Fertility Centre marks the start of your treatment journey with us. It is an opportunity for a thorough discussion of your situation with one of our Fertility Consultants.
This usually lasts about an hour, which allows plenty of time to discuss in detail both your medical histories and the implications of assisted reproduction for each of you.
We will identify and discuss in great detail the fertility treatment options most suitable for you, with your particular circumstances in mind. We will offer you our expert opinion and point out everything you need to consider when you are making your decision, including the risks involved and the chances of success under your circumstances.
If you would like to go ahead, we may be able to begin your treatment as early as your next menstrual cycle, provided that your fertility assessment (AMH tests and semen analysis) and screening tests (HIV, hepatitis B and C, etc) are completed and the results available for consideration.
Step 2 – Treatment Information Appointment (TIA)
Unlike other clinics, at Herts & Essex Fertility Centre each patient is treated as a unique individual and for this, we offer an hour-long appointment with a Fertility Nurse on a one-to-one basis, prior to starting treatment.
This gives you the opportunity to study all the treatment consent forms with a fertility expert, and to ask as many questions as you want in complete privacy before you sign the forms.
Your fertility treatment cannot begin until relevant consent forms are completed and signed, as this is a legal requirement of the Human Fertilisation and Embryo Authority (HFEA) which regulates all IVF clinics in the UK.
TIA also gives you the opportunity to talk through the treatment procedure you have chosen, step-by-step. The treatment may require you to self-inject drugs, so we take
this opportunity to make sure that you are completely comfortable with the procedure. Most fertility drugs we prescribe are given by subcutaneous injection – commonly described as “subcut”– that is an injection under the skin, usually in your lower abdomen or upper thigh.
We will give you a provisional programme of dates for your treatment appointments, to help you plan time off work, if necessary.
Step 3 – Saline Infusion Sonography (SIS) and Pipelle
What is SIS?
SIS is a quick procedure used to detect any abnormality inside the uterine cavity such as polyps (small growths of endometrium), fibroids or adhesions (scar tissue).
During a transvaginal ultrasound scan a small amount of sterile saline solution is injected into the uterus via a small catheter. SIS is advisable for the female partner before any fertility treatment to confirm that the uterus is in a good condition for embryo implantation.
SIS is normally done at the same time as the Pipelle procedure, usually within a week before the start of your treatment. It is important that you are not pregnant at the time, so you must abstain from intercourse or use effective contraception during that cycle.
Please note that SIS cannot be performed if you have Pelvic Inflammatory Disease (PID).
What is Pipelle?
Pipelle is a procedure which involves medically administering damage to the lining of the womb (endometrium). Research has shown that Pipelle significantly increases the number of live births to women undergoing fertility treatment, as the “scratching” helps the embryos to attach to the lining of the womb.
The “scratching” is performed only once, usually up to 14 days before starting fertility treatment.
The Herts & Essex Fertility Centre was one of the first fertility clinics in the UK to introduce the use of this procedure as a routine. We perform Pipelle before all fresh, as well as frozen IVF cycles, and have seen a significant improvement in our success rates.
Step 4 – Ultrasound Monitoring
By now, you will have received details of all the necessary medications you need and been allocated to one of two different drug protocols, the Long GnRH Agonist Protocol or the Short Antagonist Protocol.
The Long Protocol otherwise known as “down regulation” makes your ovaries temporarily inactive which promotes easier management of your treatment cycle during stimulation by daily hormone injections. This protocol is used in women who have normal ovarian reserve. You will need an ultrasound scan to confirm that the down regulation has been successful.
In the Short Protocol, there is no down regulation and it is reserved mainly for women who have poor ovarian reserve. It is also used sometimes in women who have high ovarian reserve as a means of reducing the risks of ovarian hyperstimulation.
In both protocols you will need daily Follicle Stimulating Hormone (FSH) injections to promote the development of multiple follicles in the ovaries.
Regular ultrasound scans will help us see just how well your ovaries are responding to the injections, by counting and measuring the size of the developing follicles and the thickness of the endometrium (the inner lining of the womb).
Step 5 – Egg Collection
On the day of egg collection both partners will need to attend the unit. Today we will harvest your eggs and prepare the semen sample for insemination, which will take place later in the afternoon.
The egg collection procedure will take approximately thirty minutes, after which you will be cared for by our specialist nursing team.
Shortly after returning to recovery your partner or family member/friend will be able to join you. You should allow approximately 2-3 hours for this visit.
Before you return home you will be seen by your consultant and an embryologist, who will confirm with you the number of eggs collected, the quality of the semen prepared, and chosen method of insemination. You will also be given a laboratory guide which details what will happen over the forthcoming days as your embryos develop.
Step 6 – Embryo Development
The laboratory will contact you daily with updates regarding your embryo development, right from the morning after your egg collection. The first call (day 1) will be to inform you how many of your eggs have fertilised normally with the sperm sample provided at egg collection.
If you are having a day 2 or 3 transfer, with your permission, all excess embryos will be cultured on to day 5 or 6, to see if they are able to progress to the blastocyst stage at which time they may be frozen if they are of good quality and contain the visible and necessary structures known to give rise to a pregnancy.
The embryologists will call you daily (with the exception of day 4 when no embryos are assessed) each morning. The Laboratory Guide given to you on the day of egg collection will provide a good insight into the journey your embryos will make in our laboratory.
We strongly believe that embryo/s should be replaced at the optimum stage of development, when they have proven themselves through a process of self-selection. It is for this reason that we perform embryos transfers 7 days a week, on days 2, 3 and 5.
Step 7 – Embryo Transfer
Embryo transfer is the process by which your developing embryo/s are transferred into the uterus. This occurs 2-5 days after egg collection and will be determined by the number, development and quality of your growing embryos. The embryologist will guide when you need to attend the clinic for embryo transfer.
The procedure itself is usually simple and straightforward without the need for anaesthetic, very similar to a female cervical smear test. Prior to the embryo transfer taking place you will have the opportunity to speak both with the clinician and an embryologist, who will discuss your embryo development and the number of embryos for replacement and subsequent culture/freezing. The decision regarding the number of embryos able to be replaced is governed by our regulatory body, the Human Fertilisation and Embryology Authority (HFEA), with a maximum of two embryos permitted for female patients under 40 years of age, and a maximum of three for those over forty.
At the time of embryo transfer you will have the opportunity to observe your embryo/s on the theatre monitor and watch the embryos be loaded into the catheter used to transfer them.
Step 8 – Treatment Outcome
Your pregnancy test will be two weeks from the date of egg collection. We will advise you at embryo transfer of the date for your test, and for this test the first morning urine sample must be used to ensure an accurate result is given. You can purchase a pregnancy test kit from a local pharmacist; we recommend a non-digital test kit be used. There may be circumstances where a blood test is necessary or indicated, and we will advise you accordingly at embryo transfer should you need to attend the clinic for a blood test.
If your pregnancy test is positive you will need to continue with your prescribed medication, and we will make you an appointment for an early ultrasound pregnancy scan at the clinic in a further 3-4 weeks. If, however, the test is negative, as soon as you are ready, we will book you a follow-up appointment with one of the clinicians to discuss your cycle, answer any questions you may have and suggest future plans.
The time between the embryo transfer and the pregnancy test can be the most difficult, as you wait to find out the outcome of your fertility treatment. Some patients describe a feeling of being in limbo and many find that the days seem to pass by slowly. While there is no formal contact with the clinic staff at this time, we understand how difficult this wait can be. In addition, the odd twinge and those little aches and pains that can be worrying even during a routine pregnancy take on an even greater significance during assisted pregnancies. So if you have any questions, or if you just need some reassurance that all is well, you’re more than welcome to phone in and speak with one of our nurse coordinators. A calming, friendly voice from someone with years of fertility experience at the other end of the telephone can be comforting.