Tests for women

 
Test When to do Why it is done
Hormones : FSH, LH, E2 secreted by the brain and ovary (blood test) D2-D4 of the cycle To assess the ovarian reserve and tailor the dose of the medication.
Hormone: AMH
(blood test)
Anytime To assess the ovarian reserve and tailor the dose of the medication
Virology – Rubella, HIV, Hep B, Hep C  (blood test) Anytime To check immunity
3D scan of uterus and ovaries (internal scan) Anytime To look for any problems in the womb and assess the ovaries

Tubal test
1. HSG
X- ray based

2. HyCoSy
USG based

First half of the cycle (appointment to be booked by patients) To see if tubes are open
Laparoscopy and dye test
(under anaesthesia in theatre)
First half of the cycle To see if tubes are open.

Fertility tests for men

 

Test What to do Why it is done
Semen analysis After 3 days of abstinence (appointments
to be booked by the patient)
To assess the semen quality and offer appropriate treatment
Virology - Rubella, HIV, Hep B, Hep C  (blood test) Anytime To check immunisation

Fertility investigations and treatments explained

With the aid of blood and urine tests, scans, tubal and womb checks we can identify the cause of fertility problems. We assess your hormones, tubes, womb, ovaries and sperm function for men.

Please note you might be suitable for some of these treatments, but the NHS only offers funding in certain circumstances.

Treatments we offer

Cycle tracking
Ovulation induction with clomiphene and gonadotropins
Intrauterine Insemination with partner or donor sperms
In-Vitro Fertilisation
Intra Cytoplasmic Sperm Injection
Fertility preservation
Frozen embryo replacement

Cycle tracking

Cycle tracking is a simple process that can help you identify which days you’re most fertile. We do this by tracking your cycle through the ultrasound to predict when ovulation is going to take place. We monitor the growth of the egg sacs and also the lining of the womb.

We do ultrasound tests to detect this; we can advise you of the ideal time to have sex to give you the best chance of conception.

Ovulation induction with clomiphene citrate or gonadotrophins

Ovulation induction is a process which boosts your ovaries to release eggs, so you maximise your chance of conception through intercourse or IUI. It is generally offered to women who do not ovulate. You will take medication (as tablets or through injections) to stimulate your hormones.

The ovulation induction cycle
Day 1 : call the clinic to arrange an appointment for scan.
Day 2-4: start taking medication.
Day 10 or 11: visit the clinic for scan to see the growth of the egg bags.
Day 14: (approximate) attend the clinic for an ultrasound test. This will determine if you are about to ovulate.

For women who don't have a normal menstrual cycle, it may take sometime to ovulate. In fact, it is not unusual for ovulation to occur much later in their cycle (after Day 14). You would then need to continue attending the clinic for scan until this point.

Intrauterine Insemination (IUI)
All the videos on this section are being used with kind permission from Dr Julio Herrero and Merck Sereno group.

What does this treatment involve?
IUI involves inserting a sample of prepared sperm into womb to coincide with ovulation (when the ovary releases an egg) to increase the chances of conception taking place. Usually the ovaries are boosted with injections to produce one or two eggs. Sperms are collected through masturbation and prepared in the lab so the best quality of sperms is placed in the womb.

Why should I have IUI?
IUI, is sometimes recommended as a simpler starting point for fertility treatment. It is usually indicated for women with ovulation problems, mild sperm problems or unexplained subfertility. If you undergo more than three unsuccessful IUI attempts, we would usually recommend starting a more complex IVF treatment.

How successful is it?
The success rates for IUI using fertility drugs are around 15 per cent per cycle of treatment, provided that the man’s sperm and the woman’s tubes are healthy. Please refer to the success rate section of the website to know the age specific success rates for the centre.

Do I have to pay for the IUI treatment?
Most of the authorities who direct patients to the Homerton Fertility Centre for treatment, do not pay for this on the NHS which means you will have to pay the fees involved. Please refer to the funding your treatment section.

In Vitro Fertilisation (IVF)
All the videos on this section are being used with kind permission from Dr Julio Herrero and Merck Sereno group.

What is it?
Eggs are removed from the ovaries and fertilised with sperm in a laboratory dish before being placed into the woman’s body.

What does it involve?

For her
IVF involves taking fertility drugs to stimulate your ovaries to produce more eggs than usual. The development of the eggs is monitored by regular ultrasound scans and blood tests.

When the eggs are ready to be released, you will have an operation to collect them. The eggs are mixed with sperm and left to fertilise, after which, usually one or two embryos are placed in your womb.

For him
You will be asked to produce fresh sperm at the clinic on the day the eggs are collected. Your sperm sample will be washed and spun at high speed to select the healthiest specimens which are then mixed with the eggs.

How will I know if it has been a success?
Success is gauged by checking the pregnancy hormones in your blood two weeks following your embryo transfer. The clinic will give you the test date.

What if it does not work?
You will be invited to come and see the specialist in couple of months’ time when you settle physically and emotionally.We try to explain the likely causes and if you want to try again and are eligible through the NHS we place you on the waiting list to try the IVF cycle again.

ICSI (Intra-Cytoplasmic Sperm Injection)

What is it?
The procedure involves injecting a single sperm directly into the centre or cytoplasm of an egg which is then placed in the woman’s womb using conventional IVF methods.

Who should have this treatment?
ICSI is recommended for couples who have been diagnosed with male fertility issues such as a low sperm count, low sperm motility, or have frozen sperm or surgically retrieved sperm.
We can also use this technique for couples who have experienced poor or no fertilisation rates using standard IVF. 

Step by step guide to IVF/ ICSI pathway at Homerton

Step 1: initial specialist appointment
We will organise the investigations to confirm your eligibility for the NHS funded IVF. It is mandatory that both you and your partner attend this appointment.

Step 2: follow-up appointment (30 minutes)
You will meet again with your fertility specialist to discuss the investigations, confirm your treatment plan, have any questions answered and sign the relevant consent forms. You will then be placed on the IVF waiting list if you are eligible for NHS funded treatment. It is mandatory that both you and your partner attend this appointment.

Step 3: your treatment starts (pre-assessment appointment - 30 minutes)
You’ll meet again with your fertility specialist who will discuss aspects of the protocol are you on such as success rates, how many embryos are recommended, side effects and consents. This appointment is usually 2 months before the start of the treatment and it is mandatory for both you and your partner to attend this appointment.

Step 4: nurses appointment (45 minutes)
Your fertility nurse will order the medication you need, explains the treatment cycle timeline, and shows you how to self-administer the Follicle Stimulating Hormone (FSH) injections. We recommend both you and your partner attend this appointment. Your medication will be delivered at the address of your choice.

Step 5: treatment monitoring
Throughout your cycle, regular blood tests measure your hormone levels and ultrasounds measure the size and number of your ovarian follicles. This also helps us determine the appropriate time for egg collection. If you choose to come alone on this appointment, you may however your partner is welcome.

Step 6: trigger injection
Once you have the optimum number and size of follicles, we plan your egg collection. You will have a trigger injection in the evening, and the operation for egg collection will occur 35 to 37 hours later. The HCG injection replaces the natural luteinising hormone in the body and 'triggers' or instigates ovulation. 

Step 7: egg collection

Egg collection is undertaken in day surgery, usually under ultrasound guidance. Most women prefer a light general anaesthetic. You will be at the hospital for about 4 hours and will need someone to drive you home afterwards. Make sure you can take the rest of the day off work.
On the morning of your egg collection your partner will need to provide a fresh semen (sperm) sample, so we can immediately fertilise your eggs.

Step 8: egg fertilisation
Collected eggs are taken to the laboratory and placed in a culture medium to prepare them for fertilisation later in the day. In IVF, prepared sperm and eggs are placed together in a dish where fertilisation occurs. In ICSI, an individual sperm is selected by a highly experienced embryologist, and, under very delicate microscopic control, the egg is injected with this single sperm.

Step 9: embryo development
The egg and sperm are then placed in individual incubators at 37 degrees to mimic the temperature of the human body. The next day, scientists will examine the eggs to determine if fertilisation has occurred, and will call you to advise you of the development of the embryos.

Step 10: embryo transfer
Embryo transfer is a simple day surgery procedure and usually takes place five days after the egg collection. The embryos are transferred into the uterus through a very fine catheter passed through through the cervix, a procedure similar to a pap smear. In some cases we may recommend transferring embryos earlier.

Fertility preservation (egg, embryo or sperm freezing)

Fertility preservation is only available for cancer patients over the NHS if they meet the eligibility criteria set by the CCGs. Please note, egg or embryo freezing for social reasons is not available at the Homerton.

All fertility preservation patients referred for cancer are seen within a week and looked after by the onco-fertility team. The average time that treatment starts for the majority of women is 2 weeks.

Egg/embryo freezing
What is fertility preservation for women undergoing cancer therapy?
The modern available treatments for cancer allows women to be treated completely in many cases. However, the chemotherapy and/or radiotherapy used to treat the disease may effect fertility in different ways. We offer fertility treatment to either preserve your eggs or embryos, so you can have an opportunity to start a family when you have completed the treatment.

Freezing of oocytes (unfertilised eggs)
This is suitable for women without a partner. It is different from embryo freezing because your eggs are not fertilised. When you wish to have babies the eggs will be thawed and mixed with sperm from your partner, to create embryos. The survival of frozen eggs is good, however they do not fertilise as well as fresh eggs. Success rates are lower than with frozen embryos. However, these techniques are constantly evolving and the current pregnancy rate is about one in five.

Embryo freezing
If you are in a stable relationship, you might wish to create and preserve embryos. The resulting fertilised eggs (embryos) are then frozen by a special technique. These embryos can be stored for up to 10 years in the first instance. Storage may then be extended depending upon individual circumstances.

Does the NHS fund freezing and storage for me?
Depending on the area you are coming from NHS will fund for the first five years or till you are 42 years of age. Please discuss with your doctor about your eligibility.

Consents
Under the terms of the Human Fertilisation and Embryology Act (1990) you are required to give written consent depending on what treatment you are going through.

key points about consent

  1. you can change your consent any time before the embryo is replaced.
  2. if you have stored embryos, it is important to remember both partners involved in the initial treatment must provide written consent at the time when the embryos are replaced. If your partner withdraws his consent, it will not be possible for us to replace the embryos.
  3. We stress strongly that you keep a copy of the consent for future reference.

See the links below to see the consents we use in the clinic for various treatments.

The staff at the centre will help you understand the consent procedure.

Frozen embryo replacement

Why are embryos frozen at Homerton ?

  1. To store any surplus embryos of excellent quality left over after the fresh transfer. This usually happens because we do not transfer any more than 1 or two good quality embryos to reduce the risk of the multiple pregnancies.
  2. If your ovarian reserve is very high we electively freeze the embryos to decrease the side effects and improve the chances of the pregnancy. You are advised to come at a later date to have the embryos replaced.
  3. If the level of the monitored hormones are high during the stimulation cycle we advise you to freeze the embryos electively. You are advised to come at a later date to have the embryos replaced.

What does freezing involve?
We freeze embryos with a technique called as vitrification. Embryos are usually frozen at Day 3 or Day 5. They are placed in thin plastic straws, sealed at both ends, and labelled with your name and identification number.
They then go into a freezing machine, where the temperature rapidly drops to -150° Celsius. The straws are then placed in goblets, and put into tanks filled with liquid nitrogen, which keeps the temperature at -196° Celsius.

Will the embryos survive freezing? 
With vitrification we expect more than 95% of the embryos to survive the thaw process.

Does the NHS fund freezing and storage of embryos?
Depending on where you live, the NHS will fund an initial 5 years of storage and freezing or till you are 40 years of age. The NHS will also stop funding the storage if you have a live birth from your treatment.

Do I have to go through the typical IVF cycle again to have a frozen embryo replacement? 
You will have to take medications to prepare your womb to receive the embryos. The advantage of this treatment is that there is no need to use hormone injections to stimulate the ovaries.