Fertility Care in Northern Ireland
Posted on February 22nd, 2016
Categories: Advances in Fertility, Fertility Treatments, Pregnancy Advice
If you’re concerned that you or your partner’s fertility may be preventing you achieving a pregnancy seeking help can be a daunting experience, especially if you do not know what to expect. Here is an outline of the main fertility tests available for men and women. Not all couples will require all available tests in order to make a diagnosis and treatment options.
Fertility tests for men
Sperm test; In around one-third of cases in the UK, fertility issues are due to the male partner. A lack of sperm or poor sperm quality can result in a failure to conceive. The male partner will be asked to produce a sperm sample for analysis. Prior to the analysis your doctor will ask you not to ejaculate for 3-5 days before the sample is to be collected. The male will be given a specimen pot to produce semen directly into. Ideally, this should be done at the clinic, however if this is not possible the sample will need to be delivered to the laboratory within one hour. For most men the sperm test is the only fertility test required.
Other tests for men;
Other tests which may be requested are a physical examination, STD testing, genetic testing, blood tests to assess hormone levels, vasography (x-ray to check for obstruction),ultrasound or testicular biopsy
Fertility tests for women
Ovulation blood tests;
Hormone imbalances can cause disruption to ovulation, preventing eggs from being released. A sign of ovulation problems is irregular periods and a blood test can help determine if this is the case.
Test for chlamydia;
Chlamydia can cause pelvic inflammatory disease and lead to fertility problems. This can be identified by a urine test or a vaginal swab.
Ultrasound scan;
A transvaginal ultrasound scan may be required to the woman’s ovaries, womb and fallopian tubes. This test involves a small ultrasound probe being placed inside the vagina.
Hysterosalpingogram (HSG) – X-ray of fallopian tubes;
An HSG involves opaque dye by injected through the cervix while an x-ray is carried out. The dye will allow your doctors to see if there are any blockages which may prevent eggs travelling down your fallopian tubes.
Diagnostic laparoscopy;
This test will only be carried out when endometriosis is suspected or in cases of unexplained fertility. It is a keyhole surgery that requires general anesthetic and allows a doctor to investigate damage to the womb and fallopian tubes and remove endometriosis tissue or fibroids.
Fertility Tests designed for the couple;
In cases where there have been recurrent miscarriages genetic karyotyping may be done to discover genetic disorders that may cause miscarriage. This test is done through a simple blood test.Fertility tests will uncover a cause in approximately 80% of cases and after the tests are completed your doctor will discuss the treatment options most suitable for you to achieve successful conception.
In vitro fertilisation (IVF) is a generic term that also includes the microinjection method of fertilisation (ICSI). The term refers to fertilisation outside the body, usually in a dish, and ‘in vitro’ is Latin that literally means ‘in glass’.
The female is prescribed fertility drugs to encourage the ovaries to produce more eggs than usual in a normal monthly cycle. This is usually in the form of a daily injection. The development of the follicles, which are the fluid filled sacs that contain the developing egg ,is monitored carefully through regular ultrasound scans and when they have grown to a required size a final injection is administered to help the eggs to mature.
The eggs are collected under mild sedation and involves passing a fine hollow needle under ultrasound guidance through the vaginal wall into the follicle when the fluid containing the egg is aspirated. The eggs are kept in an incubator which mimics the body.On the same day the sperm is prepared followed by insemination of the eggs either by mixing or injection. The fertilised eggs are developed into embryos and the ones most likely to create a pregnancy are transferred back into the uterus. This procedure does not require sedation.
The final stage is then to take a pregnancy test approximately two weeks later.
The cost for IVF treatment will vary depending on whether natural insemination or microinjection is used and all the costs involved are available as a Pdf on the Origin web site.
There is no evidence that long-term use of the Pill affects fertility. Young women today often use oral contraceptives for 10 or 15 years before they decide the time is right to have a baby. Many may fall pregnant immediately but others may experience some disruption to their menstrual cycle for a few months after stopping the pill. Most women will find that regular periods return within six months. When you stop the pill you need to wait for a proper bleed to occur. You can either use this first one or wait for the next one in order to input your dates into the calendar.
To use the calendar input the first day of your bleed and then complete the average length of your cycle and the average length of your ‘luteal phase’, the part of your cycle which starts at ovulation and ends the day before your next period. On a 28day cycle you should ovulate around day 14 and you can check this by using an over the counter LH kit that measures the rise in your luteinizing hormone which happens at the time of ovulation. The time from your LH surge to your next bleed is the length of the luteal phase. The ovulation calculator will then tell you which days you’re at your most fertile, including the date ‘most likely’ for you to conceive.
If you have been on pill for a long time it may take a few cycles to regulate again so it is your decision as to which cycle to start using the calendar.
Infertility is defined as a failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Of course getting pregnant is influenced by age so if the female is in her late 30s you may wish to seek help earlier.
Anyone can seek treatment for infertility issues privately without waiting. Individual clinics will operate their own age limits, which at Origin Fertility Care is 45 for the female using her own eggs and 60 for the male. Other criteria, such as BMI and welfare of the child issues will also be taken into consideration.
NHS funded treatment is more difficult to secure. In Northern Ireland treatment is limited to couples with a medical cause for infertility. Couples must either have a diagnosed cause for their infertility or have been unable to conceive without a recognised cause for three years. The upper age limit for the female is 39 years and treatment must be completed by the age of 40. However, if you have had more than 3 unsuccessful treatments elsewhere or have a BMI more than 35 you would not be eligible for NHS funded treatment.
If you meet all the criteria you can be expected to be offered one NHS funded cycle of IVF / ICSI and one frozen embryo replacement cycle if embryos are available. The process of GP referral to a regional fertility centre to actual treatment however is a long one and can take between 2 to 3 years.
The chances of natural conception declines with age and the figures published by the National Institute of Clinical Excellence (NICE) are shown in the following graph. This data suggests that 30 % of women aged 35 will conceive after trying for one year.
The chance of achieving a pregnancy after fertility treatment is considerably higher, but is different for each patient. Important factors such as female age, reproductive health, sperm quality and fertility history are all influencing factors that are considered before Origin Doctors can give realistic advice about an individual’s chances of having a baby.
Currently Origin has released figures showing that 47 % of patients up to the age of 35 years have achieved a pregnancy after treatment. In the same period 44% of patients between 35 and 38 and 29% between the ages of 38 and 42 achieved a pregnancy after treatment.
The Human Fertilisation and Embryo Authority (HFEA) is the UK’s independent regulator overseeing the use of gametes and embryos in fertility treatment and research. The HFEA presents success rates for every licensed clinic and the rates reflect the number of treatments carried out by the clinic in a particular year and the number of pregnancies or live births that were born as a result. Clinics are then rated by whether the clinic’s success rate is above, below or consistent with the national average success rate across all clinics.
