Dora Koutsospyrou, Author at Herts & Essex Fertility Centre https://hertsandessexfertility.com/author/herts/ World class fertility centre. Outstanding success rates. Wed, 02 Aug 2023 09:53:41 +0000 en-GB hourly 1 https://wordpress.org/?v=6.9.4 Endometriosis and infertility https://hertsandessexfertility.com/all-about-endometriosis-and-infertility/ Mon, 13 Mar 2023 16:53:37 +0000 https://hertsandessexfertility.com/?p=2162 What is endometriosis? Endometriosis is a condition in which tissue that normally lines the inside of your womb (endometrial cells), grows outside your uterus. The endometrial cells could grow in ...

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]]> https://hertsandessexfertility.com/wp-content/uploads/2019/09/Endometriosis2.pngWhat is endometriosis? Endometriosis is a condition in which tissue that normally lines the inside of your womb (endometrial cells), grows outside your uterus. The endometrial cells could grow in ovaries, fallopian tubes, bowel, bladder, and lining of your pelvis. On the odd occasion, endometrial tissue may spread beyond pelvic organs to the lungs or skin. Endometriosis can affect any woman of reproductive age, which can be anything between the ages of 15-49 years on average. The displaced endometrial tissue continues to act as it normally would; it thickens, breaks down, and bleeds with each menstrual cycle. As this displaced tissue cannot exit your body, it becomes trapped. If the endometriosis is in the ovaries it can create a cyst called endometriomas which can irritate the surrounding tissue and eventually develop scar tissue and adhesions. Abnormal bands of fibrous tissue can also cause pelvic tissues and organs to stick to each other, causing tubal blockage or obstruction of the bowels.

What causes endometriosis?

A definite cause for endometriosis has not been confirmed. However, several theories have been suggested including:
  • Genetics: Endometriosis tends to run in some families and is more prevalent in certain ethnic groups.
  • Retrograde menstruation: some endometrial cells flow through the fallopian tubes into the pelvis, embed and develop a blood supply, instead of flowing out of the body through the cervix during periods.
  • Endometrial cells spread from the womb, through the bloodstream or immune circulation (lymphatic system). This theory explains endometriosis found in distant organs such as the lungs and their lining.
  • Abnormal immune function, allowing endometrial cells to develop outside the womb and enabling inflammation and scarring

Symptoms and signs of endometriosis

The main symptom of endometriosis is pelvic pain, often during the menstrual period, typically describe as far worse than usual. Women with endometriosis also tend to report that the pain increases over time.
  • Painful periods, with pelvic pain and cramping, may begin before the period and extend several days into it. The pain can be so severe that it prevents you from normal activities.
  • Excessive bleeding. You may experience occasional heavy periods or bleeding between periods
  • Deep pelvic pain with intercourse either during or after sex is common with endometriosis.
  • Pain with bowel movements or urination.
  • Blood in stools or urine during periods due to endometriosis involving the bladder and bowels
  • Women with endometriosis can find it difficult to get pregnant naturally
Other symptoms during your period are fatigue, diarrhea, constipation, bloating, or nausea, especially during menstrual periods.

Other conditions

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation, and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis. Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis end temporarily with pregnancy and end permanently with menopause, (unless you're taking estrogen hormone replacement therapy-HRT). It takes on average 7-10 years from the onset of symptoms to diagnosis in many cases. However, with better information, women are getting referred to see specialists earlier. With improving non-invasive ultrasound imaging, early diagnosis is possible, with prompt treatment, resulting in much better outcomes.

How is endometriosis managed?

There are medical treatments, including painkillers and hormonal tablets or injections which are very effective, especially in pain management. However, they are in some cases contraceptives as well and not suitable for those wishing to conceive. Surgical removal of endometriosis is mainly performed as a key-hole procedure, laparoscopy. In the vast majority of cases, this is a day surgery procedure. Endometriosis ovarian cysts; blocked and damaged tubes and other pelvic endometriosis lesions can be managed in this way to treat pain and infertility.

Endometriosis and Infertility

The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant. To conceive, an egg must be released from the ovary, travel through the fallopian tube, become fertilized by a sperm cell within the fallopian tube, start dividing and travel down the fallopian tube over a five-day period before getting into the uterine cavity, and implant into the uterine wall lining to continue its development. Endometriosis may obstruct the tube and keep the egg and sperm from reaching each other and fertilising. The transport of a fertilised egg through the fallopian tubes may also be impeded, with resulting implantation within the fallopian tube, known as an ectopic pregnancy. Endometriosis also seems to affect fertility in less-direct ways, such as damage to the sperm or egg. Medication doesn’t always improve fertility. Surgery to remove visible patches of mild to moderate endometriosis tissue can sometimes help. However, in severe cases of endometriosis, the chances of a spontaneous conception are lower. Surgery in severe cases may alleviate the pain symptoms and improve the chances of successful fertility treatment. If you're having difficulty getting pregnant, infertility treatments, such as in vitro fertilisation (IVF), may be an option. Even so, many women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors advise women with endometriosis who wish to have children not to delay having children because the condition may worsen with time.

Endometriosis and Ovarian cancer

Ovarian cancer does occur at higher-than-expected rates in women with endometriosis. Thankfully, the overall lifetime risk of ovarian cancer is low, to begin with. Some studies suggest that endometriosis increases that risk, but it's still relatively low. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in women who have had endometriosis.

When to seek help

See your GP if you have signs or symptoms of endometriosis, especially if they have a big impact on your quality of life. Your GP will examine you, arrange tests and if endometriosis is suspected, refer you to a specialist. Our endometriosis and fertility specialists at Herts and Essex Fertility Centre provide advice, investigations, and all forms of endometriosis treatment. You do not require a GP referral to arrange an appointment. Following your appointment, your GP will be kept informed of your investigations and treatment. Contact our fertility experts on 0199278 50 60 to discuss how we can support you.  ]]> 30 Years of making babies with love & science https://hertsandessexfertility.com/30-years-of-making-babies-with-love-science/ Wed, 17 Jul 2019 15:13:03 +0000 https://hertsandessexfertility.com/?p=2074 On 13 July 1989 Michael Ah-Moye, CEO, and Consultant Gynaecologist opened the doors to a new fertility clinic, now known as the Herts & Essex Fertility Centre.  And on Saturday ...

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]]> https://hertsandessexfertility.com/wp-content/uploads/2019/07/DSC_2717-e1563375811649.jpgOn 13 July 1989 Michael Ah-Moye, CEO, and Consultant Gynaecologist opened the doors to a new fertility clinic, now known as the Herts & Essex Fertility Centre.  And on Saturday 13 July 2019, we celebrated 30 years of successful IVF and fertility treatment at our clinic in Cheshunt, Hertfordshire.  More than 400 parents, babies and children, in a poignant reunion, joined our 30 members of dedicated staff, to celebrate the fertility journey we have shared, over the past 30 years. We celebrated this milestone with a joyous, fun filled garden party at the clinic where Michael welcomed families from the past 30 years. Michael, “the gentle guiding father figure of Herts & Essex Fertility”, started his career in IVF in 1984, six years after the birth of the first successful IVF baby. He has witnessed all the major breakthroughs and developments in the field of IVF and Fertility treatment these past 35 years, which one takes for granted today. Peter Brinsden (retired Director of Bourne Hall Clinic) who worked alongside Michael and spoke about their early years in an emerging speciality, had remarked “While we were out there shouting about it, Michael Ah-Moye was in his clinic in Essex doing it!” The first successful IVF baby was born in England in 1978.  In 1985, Michael Ah-Moye joined Professor Ian Craft, a renowned IVF pioneer, at his new IVF unit in London. Prof. Craft was the second person in the UK to produce an IVF baby and he was responsible for many breakthroughs that changed the practice of IVF forever. In 1989, Michael founded the Essex Fertility Centre at Holly House Hospital in Essex.  18 years later, the team relocated to their current purpose built clinic in Cheshunt, Hertfordshire, and was renamed the Herts & Essex Fertility Centre. Our IVF treatment success rates are among the highest in the country, as confirmed by the Human Fertilisation & Embryology Authority (HFEA) database. Our dedicated team has helped to create thousands of happy new families with the successful delivery of over 6,000 babies since 1989. In addition to IVF, we offer a range of treatments including fully funded IVF options with an Egg Donation scheme, in-house Sperm Bank, Egg, Sperm and Embryo freezing treatments, surgical sperm retrieval, award-winning Surrogacy with outstanding results and more. Fulfilling our promise to provide the most up to date treatments in a professional, caring and dedicated manner, we keep our patients’ best interest foremost. The Fertility Journey: 1978 - First successful IVF baby born in the UK 1984 - Michael Ah-Moye, CEO and Consultant Gynaecologist at HEFC started his career in IVF 1984 – Introduction of Human Embryo Freezing 1985 – Michael joined IVF pioneer, Professor Ian Craft to open his new IVF unit in London 1985 – Buserelin, a drug to prevent premature release of eggs during IVF, approved for medical use 1986 - First egg donation treatment in the UK 1987 - Vaginal scanning and vaginal egg collection 1988 – Introduction of Pre-implantation Genetic Diagnosis (PGD) to screen embryos for genetic abnormality 1989 – Founded Essex Fertility Centre at Holly House Hospital in Essex 1990 - Introduction of Anti Mullerian Hormone (AMH) test for checking egg reserve in women 1992 – ICSI breakthrough in Belgium 1999 – HEFC First IVF clinic to pioneer the use of a Blastocyst Transfer in the UK 2007 – Herts & Essex Fertility Centre in Cheshunt, Hertfordshire opened, following relocation 2014 – First live birth from Uterine transplant in Sweden 2019 – 30 years of making babies with love and science   “It is a brave new world, and undoubtedly science and technology will open up even more successful and safer frontiers in IVF & Fertility treatment” said Michael in his welcome speech. If you would like to know more about IVF or other fertility treatments, do contact the HEFC and join us at one of our Open Days / Open Evenings which are held on a regular basis.]]> What you need to know about semen analysis https://hertsandessexfertility.com/what-you-need-to-know-about-semen-analysis/ Thu, 06 Jun 2019 13:15:59 +0000 http://hertsandessexfertility.com/?p=1904 What is a semen analysis? A semen analysis is a very important non-invasive diagnostic test used to evaluate male fertility and should be one the first investigations for a couple ...

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]]> https://hertsandessexfertility.com/wp-content/uploads/2019/06/SemenAnalysisLucyBlog-1-e1559907879432.pngWhat is a semen analysis? A semen analysis is a very important non-invasive diagnostic test used to evaluate male fertility and should be one the first investigations for a couple having difficulty conceiving. Male factor infertility can be due to abnormalities in sperm production, sperm function, or both and accounts for 40-50% of all infertility cases. A semen analysis can also be performed to confirm the effectiveness of a vasectomy or a vasectomy reversal. A semen analysis is also necessary if you wish to become a sperm donor.

How is a semen analysis performed?

The male patient will be asked to produce a semen sample into a specialised container provided by the laboratory which is sterile and non-toxic to sperm. The container will be clearly labelled with the patients details. Ahead of this appointment, it is very important to abstain from ejaculation for three to five days. A shorter or longer period may affect the results of the test. We would also recommend producing the sample at the clinic to control the time between production and analysis to minimise any temperature or environmental fluctuations which could also affect the test results.

The sperm test

Our highly-trained and experienced laboratory personnel will initially analyse the appearance and physical properties of the semen sample before using a microscope to examine the sperm cells themselves in detail. The parameters seen will be compared to the World Health Organisation (WHO, 2010) reference values below.
Parameter WHO 2010 Reference Value
Volume > 1.5ml
Viscosity Normal
Liquefaction Complete
Sperm concentration > 15 million/ml
Total sperm number >  39 million
Total sperm motility > 40%
Progressive motility > 32%
Normal morphology > 4%
Agglutination/MAR binding. < 50%
Normal Level
Hyaluron Binding Assay Score > 65%
 

Assessment Parameters

Semen Volume
Seminal fluid is composed of secretions from the seminal vesicles, the prostate gland, the bulbourethral glands and epididymides. The first part of the ejaculate contains the prostatic fluids which are rich in sperm. For this reason, if any of the ejaculate is not collected it will affect the semen analysis result, especially if it the first fraction. Laboratory staff must be informed if this is the case. Normal ejaculatory volume is upwards of 1.5ml.
Liquefaction and Viscosity
When a semen sample is freshly collected, it will take the form of a semi-solid mass which becomes liquid a free flowing fluid through a process known as liquefaction. Incomplete liquefaction may indicate a deficiency of prostatic enzymes. Viscosity describes the fluidity of the sample. A viscous sample will be sticky and may adhere to the sample pot. A sample with incomplete liquefaction or high degree of viscosity can affect the assessment of sperm concentration and motility.
Sperm Concentration and Total Sperm Number
Sperm concentration is the number of sperm cells per ml of seminal fluid produced. The lower reference limit for sperm concentration is 15 million sperm per ml of seminal fluid produced. Sperm concentration is a predictor of conception and related to pregnancy rates. A sperm sample with a concentration is less than 15 million per ml is termed oligozoospermic. Sperm concentrations can fluctuate and it is always advisable to have two or three samples tested to establish a baseline reading. The total sperm number is the number of sperm in the entire sample and can be calculated by multiplying sperm concentration with sample volume. A normal total sperm number is 39 million or above.
Total Sperm Motility and Progressive Motility
Motility describes the ability of sperm to swim which is pivotal to natural fertilisation. Motility is calculated as a percentage of swimming (motile) sperm compared to non-swimming (immotile sperm). Total sperm motility should be 40% or greater. Progressive motility is a subjective evaluation of the sperm movement used as a measure of how fast the sperm are swimming to measure their ability to swim towards the egg. Progressive motility is where the sperm are actively swimming. Non-progressive motility is where the sperm are moving but not travelling forwards. Immotile sperm do not swim. Sperm motility can be influenced by abstinence period, patient age and health and also external factors including toxins and excessive heat.
Morphology
Morphology refers to the physical appearance of the sperm and whether the sperm are normal in  shape. A morphologically normal sperm will have a smooth oval head with a single unbroken straight tail connected to the head with a straight mid piece. In a normal semen sample as many as 96% of the sperm are identified as abnormal, which in itself is completely normal! There is a direct link between sperm morphology and fertilisation potential and some sperm will not be able to fertilise an egg due to their shape.
Agglutination
In order to fertilise an egg, sperm should be swimming freely and not stuck to each other. Agglutination of sperm occurs when the head or tail of one sperm sticks to another sperm restricting the motility of the sperm. Severe agglutination can affect the assessment of sperm motility and concentration. The presence of agglutination can be indicative of the presence of anti-sperm antibodies whose presence can be determined using a MAR (Mixed Antiglobulin Reaction) test.
MAR TEST
The MAR test can determine the presence of anti-sperm bodies (ASABs). ASABs in semen can cause the sperm to agglutinate together and impair the ability of the sperm to reach and bind to the outside of  the egg.  ASABs can arise following testicular trauma or surgery. Sperm in the testicles are protected from circulating antibodies by the blood-testis barrier. A breach in this barrier can lead to antibody formation and the secretion of antibodies into the accessory glands which form a large proportion of the seminal plasma. The result is clinically significant when greater than 50% of the sperm are bound.
Hyaluron Binding Assay
The Hyaluron Binding Assay (HBA test) is a highly specialised test to assess the proportion of mature sperm with the semen sample. Sperm maturity is important because only mature sperm can naturally fertilise an egg. Therefore if levels of mature sperm within the sample are low, this means the is a reduced number of sperm cells which have fertilisation potential. A normal HBA score would be upwards of 65%. Herts and Essex Fertility Centre include this highly specialised as standard within all of our semen assessments.
What happens if there are no sperm in the sample?
A sample with no sperm cells present is described as azoospermic. A sample is considered apparently azoospermic after the sample is processed by centrifugation, a technique which uses a gravitational force on the specimen to drive any sperm present in the sample into a pellet at the bottom of the test tube.  A second semen analysis will be requested to confirm the diagnosis. To understand the potential cause of the azoospermia, a medical investigation evaluating the testes and blood sample for hormone profiling for FSH (Follicle stimulating hormone), LH (Luteinizing hormne), testosterone and prolactin will be recommended. Azoospermia can be due to inadequate stimulation of the testes, an obstruction of the post testicular genital tract or testicular failure. The diagnosis will determine eligibility for the surgical recovery of epididymal or testicular sperm to be used for ICSI (Intra Cytoplasmic Sperm Injection). Interpretation of the Results Semen sample results may exhibit natural variation over time, meaning a single semen sample may not be representative of a man’s average semen characteristics. The outcome of a semen assessment can be influenced by a variety of factors including lifestyle, testicular damage, and pharmaceutical agents. For this reason, it is not unusual to be asked for a repeat semen analysis.
Terminology Description
Normozoospermia A normal sperm sample
Oligozoospermia A low sperm count
Azoospermia No sperm cells in the sample
Asthenozoospermia Poor sperm motility
Teratozoospermia Poor sperm morphology
Oligoasthenoteratozoospermia Low sperm count with low motility and morphology
Aspermia No semen produced
Hyperspermia Large volume of semen
Hypospermia Small volume of semen
  Making an appointment for a semen analysis is quick, easy and strictly confidential, and you do not need a GP or hospital referral. Simply call us on 01992 78 50 60 or email enquiries@hertsandessexfertility.com.  ]]>