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Before treatment begins

There are a number of things that have to be done before your treatment can begin.

Selection Criteria

Although IVF and other fertility treatments can bring huge benefits to some people, for others they are not appropriate.  For these people, allowing treatment to start would only bring false hope and heartache.  We would not want anyone to have to go through this.

At the Hull IVF Unit we will not allow treatment to be started if we do not believe that the chances of success are reasonable.  It is for this reason that we have introduced selection criteria:

  • We will not offer treatment to ladies over the age of 45. After the age of 40, the chances of success become slim.  It is for this reason that we will treat ladies over the age of 40 subject to them undergoing counselling and tests to ensure that their ovaries are still functioning.
  • We will not offer treatment to patients with a BMI of 35 or over. The BMI (body mass index) is a measure of body “fatness.” It is calculated by dividing your weight in kilograms (kg,) by your height in metres squared (m2). You are much less likely to achieve a pregnancy after treatment if your BMI is over 35.  You are also more likely to experience problems during pregnancy, such as miscarriage.

If you have any questions about our selection criteria, please feel free to contact us.

Screening Tests

Before you commence treatment, some investigations must be performed to ensure that you are both suitable for this type of treatment.  If you feel that you have already had any of these investigations please let us know.

AMH:  AMH is a hormone measured from a blood test.   This blood test needs to have been carried out recently to help us judge what drug regimes will suit you.

Prolactin (for the woman):  Prolactin is a hormone measured from a blood test.  

Antral Follicle Count (for the woman): An Antral follicle count is performed by ultrasound scan.

Rubella (for the woman):  A blood sample will be taken to confirm your immunity to rubella (German Measles).  It is important to have the result of this test before your treatment starts.  If you are shown to be "not immune" you must discuss the need for immunisation with your own general practitioner or infertility specialist.  Any immunisation or repeat immunisation must be done before starting the treatment cycle.

Screening for HIV and Hepatitis B and C:  Before treatment can commence, both partners must be screened for Hepatitis B surface antigen, Hepatitis B core antibody, Hepatitis C and HIV infections.  The Hull IVF Unit does not have the facilities required to treat those patients who are HIV and Hepatitis positive or those patients.  Arrangements will be made for referral of these patients to a centre equipped to meet their needs.  The implications of this testing will be explained to you, and counselling will be available, prior to being tested.

Chlamydia screening:  Chlamydia is a micro-organism which can lead to damage of the fallopian tubes.  It is tested using a urine test for the male partner and a vaginal swab for the female partner.  It can also be tested by taking a blood test to investigate the presence of antibodies to Chlamydia.

Cervical smear:  It is necessary for you to have had a cervical smear within the last three years.  If you have not had a recent smear, please visit your GP to arrange this before your treatment starts.  If you are not on a normal recall with your smear tests then we need a clear smear test within your recall, e.g. 6 months, 12 months etc.

Semen evaluation:  Although you may have had a Semen Analysis carried out recently in the hospital, we may still require this to be repeated.  The booked test, where the sample is produced on site, is more detailed and gives us more information, allowing us to determine how treatment will be attempted.  (This may not be necessary for those patients requesting treatment with donor sperm).

Lupus Anticoagulant, Anticardiolipin antibody screening, B2 Glycoprotein antibody screening and TSH:   These blood tests may help the clinician assess whether you have an increased risk of a miscarriage or an increased risk of problems during pregnancy.    There are many reasons why ladies may miscarriage and not all risks can be assessed by a blood test.   However, if these blood tests show any abnormalities the clinician can initiate treatment to reduce the risk for you.

Tubal patency test:  This investigation can be done in one of two ways;

  • HyCoSy      - an ultrasound investigation of the fallopian tubes.  A fluid, which is opaque when viewed by      ultrasound, is infused through the tubes.       The sonographer will observe the fluid to determine if it spillsfreely from the end of the tubes and over the ovaries.  If the fluid is not seen to pass through the tubes a laparoscopy and dye (see below) will be organised to assess your tubes further.
  • Laparoscopy      and Dye- Performed in theatre under a general anaesthetic.  An endoscope is passed into pelvic      cavity through the navel.  Dye is      passed through the cervix into the uterus.       The surgeon will then watch the dye pass through the tubes.  If the fluid is not seen to pass through      the tubes we would assume the tubes may be blocked.  If any other disease such as      endometriosis is found this will be treated at the same time. 

Ultrasound scan: All patients having IVF will have an ultrasound scan carried out to exclude cysts in the ovaries, fluid within in the fallopian tubes (hydrosalpinges) or fibroids in the uterus. 

The management of these, if necessary, will be discussed with you before treatment commences. 

 All investigations must be up to date before commencing a treatment cycle and the office staff will liaise with you regarding any investigations that are outstanding.   If you have any queries regarding this please do not hesitate in contacting us .

Keeping yourself healthy

Keeping yourself healthy will maximise your chance of the treatment being successful. Before treatment starts, both partners should:

  • Stop smoking
  • Stop drinking alcohol
  • Eat a healthy, balanced diet.

We also strongly recommend that the female partner takes a daily folic acid supplement. The dose of the supplement should be 400mcg. These supplements are available from your local chemist. Taking folic acid helps to reduce the risk of your baby being affected by some birth defects, such as spina bifida.

The Welfare of the Child Assessment

By law, we must ensure, to the best of our abilities, that any children born as a result of treatment at our Unit will not be likely to face medical, physical or psychological harm. We must also ensure that the welfare of any existing children you may have will not be affected by your treatment.

The Welfare of the Child Assessment is simple and straightforward. Nearly all of our patients go through this assessment process without any concern.

The assessment is carried out in two parts:

Firstly, both partners will be required to complete a form. This form will ask about topics such as previous convictions related to harming children, contact with social services over the care of existing children, violence, alcohol and drug abuse, serious medical or mental health conditions and serious inheritable diseases in the family.

If any of these topics are relevant to you, you will not automatically be refused treatment. We will need to gather more information before a decision is made based on your individual case. We may need to speak to other people outside the Unit such as your GP, other doctors or probation officer, but please remember we will not contact anybody without your explicit, written consent.

Secondly, we will give you a form to take to your GP. If appropriate, your GP will sign this letter to confirm that he/she knows of no reason why you should not be treated.

Please do not hesitate to contact us if you have any questions relating to the Welfare of the Child Assessment.

I am a single woman. Can I be treated?

Women are not denied treatment simply because they are single. We will, however, need to ensure that you will be able to cope with the additional pressures that single parenthood will bring. Before treatment can begin we will need a social report, a counselling report and approval from the Ethics Committee. For more information about options for single women, please do not hesitate to contact us.

Consent

We will need you to sign official HFEA (Human Fertilisation and Embryology Authority) consent forms before any treatment can begin. For more information about the consent forms, please refer to the patient information booklet.