The initial consultation
On your first visit, we encourage both patient and partner to attend. An in-depth medical, social, gynaecological and fertility history will be taken. In addition, the following preliminary tests may be recommended to be carried out, either at this appointment or soon after:
For the woman:
Blood test for hormone levels:
- FSH (follicle stimulating hormone): the FSH reading taken between day 2 and 5 of a menstrual cycle gives us an indication of how the ovaries are functioning and is helpful in calculating drug doses for treatment
- LH (Luteinising hormone)
- TSH (Thyroid stimulating hormone)
- Anti Mullerian hormone: this is a helpful test for checking ovarian reserve. It indicates how well a patient is likely to respond to medication.
Not all patients require all of these blood tests and, indeed, some GPs may have already performed some of these. There will not be unnecessary duplication of these tests, although some may need to be repeated if abnormal or out of date.
Sometimes, depending on the patient’s history, additional tests may be required. These will be fully explained to you.
Baseline ultrasound scans: A transvaginal (internal) scan is used to assess the uterus and ovaries. Abnormalities of the uterus are checked for such as fibroids, polyps and congenital abnormalities. The ovaries are also checked for size, appearance and cysts.
Occasionally a problem may be identified that requires further investigation or surgery prior to any treatment.
For the man:
Semen analysis/sperm preparation: Before treatment all men must have at least one semen sample analysed in our own IVF laboratory. This test prepares the sperm as if it were to be used for treatment, and a recommendation made as to what fertility treatments are suitable options.
Hepatitis B, Hepatitis C & HIV: If IVF treatment is planned, both the patient and partner are required to be tested for HIV, Hepatitis B and Hepatitis C. This is required by the Human Fertilisation and Embryology Authority (HFEA).
The viruses are transmitted through blood, semen and cervical secretions, and can be passed from a pregnant woman to her unborn child.
In addition to these baseline tests, patients may be required to have additional screening or more in-depth testing, such as hysterosalpingogram, hysteroscopy or laparoscopy and dye test.
Welfare of the child
Under the terms of the Human Fertilisation and Embryology Act (1990), fertility clinics must consider ‘The welfare of any child who may be born as a result of treatment and of any other child who may be affected by the birth’. In order to fulfil this obligation, patients and their partners are required to complete a medical and social assessment questionnaire developed by the HFEA.
This is not designed to assess an individual’s suitability to act as a parent, but to ensure that the health and the welfare of any child is not compromised. Occasionally additional information may be required from the GP to support an assessment.
The second consultation
During this visit, the consultant discusses the implications of test results and the possible treatment options suitable for each patient. Further testing such as hysteroscopy or laparoscopy may be required, or a recommendation to commence fertility treatment may be made. All treatment options will be fully discussed and explanations given about which treatment is most suited to give the best chance of achieving a pregnancy.
At the nurse consultation, the proposed treatment is discussed in more detail. Depending on the type of treatment to be discussed, this appointment may last from 30 minutes to two hours. The nurse will explain about the schedule of events involved in the treatment cycle, any risks involved, potential outcomes and chance of success. If medication is required the nurse will explain how this will work, how they are administered and any possible side effects.
Written literature is provided about all treatments and a number of consent forms may require completion. A plan can then be made to commence treatment. Support from the whole team is available throughout treatment. All BMI clinics have a doctor or nurse available for emergency on call 24 hours a day, 7 days a week.