Frequently asked questions

Frequently Asked Questions about IVF and Fertility

Many patients understandably have a lot of questions before attending a clinic appointment. We have collated some of the most frequent of these so that you can find out as much as you wish to before coming in to the clinic.

If you have a specific question not answered below please contact our friendly team of fertility experts who will be happy to help. 

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IVF    
  • What’s the first step to IVF?
       

    The first step is for you to come in for an advance scan and a consultation. These both occur in one hour-long appointment. The first half of the appointment is the scan; this is an internal scan with an advanced 3D Doppler scanner and will help us assess the blood flow in the ovaries, follicles and womb as well as checking ovarian reserve. We perform a 3D scan to assess the cavity of the womb to rule out any problems for implantation. They will also check for obstructions such as cysts and polyps. Following straight on from the scan you will have your appointment where the doctor will go through the results and your medical history and devise a personalised treatment plan for you based on these.

    Do I have to come for the scan on a particular day of my cycle?

    No, you can come for the scan on any day of the cycle, including during your period if you are comfortable with this- it doesn’t make any difference from the scanning point of view.

    Do I have to have the scan done again if I’ve had one elsewhere?

    We request that every patient have a scan within 3 months before starting any treatment. It is at the doctor’s discretion whether they will accept a scan from another clinic; however most doctors prefer to have a scan performed at CREATE because our doctors have been highly trained in scanning methods and will be able to assess multiple aspects of your fertility. Our scanners are 3D Doppler scanners and look at the blood flow in the ovaries and womb as well as checking ovarian reserve.

    Should I bring anything with me?

    If you have medical notes, from previous treatment for example, you can send copies of these to us in advance to be added to your file. Otherwise you do not need to bring anything with you.

  • What is Natural IVF?
       

    Natural IVF uses fewer drugs than conventional IVF. We think that you can get the same results with fewer stimulating drugs, which is better for the patient because there are fewer side effects. The body is not designed to produce a lot of eggs in one go, so often even if there are a lot of eggs collected in conventional IVF, lots of them aren’t viable so you end up with the same amount of eggs as if you’d taken fewer drugs.  Natural IVF doesn’t use any stimulating drugs at all, and Natural Modified IVF uses just a short course of stimulating drugs: about 3-4 days worth instead of the 4-5 weeks of drugs with conventional IVF.

    Natural cycle IVF  works within a woman’s own natural cycle, so rather than shutting down the cycle and re-starting it with high stimulation drugs. Natural IVF doesn’t use any stimulating drugs at all, and Natural Modified IVF uses just a small dose of drugs as add-back therapy to support the growth of the leading follicle. This approach is based on a focus on quality rather than quantity. Natural IVF is most suitable for women with low ovarian reserve, low AMH or. high FSH

  • What is Mild IVF?
       

    Mild IVF focusses on quality rather than quantity of eggs, is conducted within a woman's natural cycle and uses fewer stimulating drugs than conventional IVF. Mild IVF uses a short 5-9 day course of stimulating drugs (rather than the 4-5 weeks worth in conventional IVF) to gently encourage the growth of the follicles.

    Mild IVF is designed to be easier on the body with fewer side effects. The short protocols with fewer drugs mean that the stress of treatment and potential side effects are reduced. There have been no cases of severe OHSS at this clinic (OHSS is a syndrome where the ovaries are over-stimulated and swell up, causing pain, bloating and sometimes hospitalisation. It is also more affordable because medication accounts for a lot of the cost of IVF, and the patient experience is better because the treatment time is shorter.

  • Should I do Natural or Mild IVF?
       

    This depends on your own set of circumstances, and the doctor will be able to tell you what’s best in the initial scan and consultation. At this appointment the doctor will do an internal scan with a 3D scanner, which will look at your ovaries and ovarian reserve, the womb lining and the blood flow to these. They will then go through your medical history and devise a treatment plan based on your scan and medical history.

    Usually older patients or those with a low ovarian reserve will be advised to go for Natural or Natural Modified IVF. This might seem counterintuitive because it seems like the fewer eggs you have, the more stimulation you need. But eggs cannot be created out of nowhere, so stimulating drugs won’t make more appear, and so a focus on collecting the best of your remaining eggs is more beneficial. Mild Stimulation IVF works well for people with a good ovarian reserve, and it has excellent success rates.

  • Do you have selection criteria?
       

    We accept any women up to the age of 50. We do not have any cut-off for AMH levels, and we will try to achieve fertility treatment for a woman with their own eggs if it is possible. We have had patients with AMH levels under 1 have healthy babies with their own eggs. We do not have a strict BMI cut-off, but will take it into account the health and safety of the woman when deciding what treatment is best suited and in some cases whether it is safe to go ahead with treatment.

  • What is the process?
       

    The first step is to come in for an initial scan and consultation. At this appointment the doctor will assess your situation and devise a personalised treatment plan. After this, you will come in 2 weeks before the start of your period to meet with a nurse. They will talk you through your treatment, give you your medication and teach you how to take it and go through the consent forms with you. You will then call up on the first day of your period (day 1) to book in your first scan. This will probably be on day 5 or 6, but could be earlier or later depending on the advice of the doctor. After the first scan, there will be around 2 or 3 more scans, usually performed every other day. The egg collection is usually performed on around day 12; this is carried out under sedation, and is followed by the embryo transfer a few days later.

  • How long does it take?
       

    After the first scan, the treatment takes about 2 weeks.

  • Is there a waiting list?
       

    No, there is no waiting list. There are usually initial consultations available within a week. Starting the treatment depends on your cycle, as it will begin after your period starts. This means we can usually start at the beginning of your next cycle.

  • What are the success rates?
       
    Our success rates vary depending on the age of the patient and the type of treatment. Our success rates for Mild IVF are excellent. We have the highest success rates in the country for Natural IVF and are usually able to help women with low ovarian reserve with Natural IVF. We are a long group of fertility clinics with a great track record of providing patients with tailor-made milder treatment. It is very important that you consider other aspects and factors of treatment other than just success rates, which may not reflect patients in your situation.
  • Can I improve my chance of success?
       

    We offer a number of technologies that might improve your chances of conceiving successfully with IVF treatment. Please discuss with a consultant to check whether any of these might be beneficial to you.

    Embryoscope: One of these is Embryoscope technology. This is time-lapse imaging of embryos while they are in the lab, and offers 2 main advantages. Firstly, the embryology team can examine the division of the embryos and see which ones are dividing as expected. These are likely to be the most healthy embryos, and can then be selected for implantation. Selecting the highest quality embryos means that the chances of success for the cycle are higher. The second advantage is that the embryologists do not have to take the embryos out of the incubator to inspect them, so that favourable conditions are maintained throughout incubation. 

    IVM: In-vitro maturation (IVM) is a pioneering technology that can be used in conjunction with Natural IVF to create more embryos. Natural IVF aims to collect one mature egg, but with IVM smaller immature follicles can also be collected and matured in the lab. Around 70-80% of these immature follicles will go on to mature and can then be used for IVF treatment.

IVF with donor sperm    
  • Who is this treatment suitable for?
       

    IVF treatment with donor sperm is most suitable for couples with a male infertility factor, female same-sex couples and single women.

    For more information, visit Treatment with Donor Sperm.

  • Do you have donor sperm?
       

    Yes we have our own Sperm Bank with a list of available donors. The donors are anonymous, but we can give you information on their ethnicity, hair and eye colour and occupation. We are happy to work with outside sperm banks if you would prefer. It is also possible to use a known donor.

  • What is the process of having treatment with donor sperm?
       

    The first stage is to come into the clinic for an initial consultation. This will include an internal scan for the female undergoing the treatment and a consultation with the doctor for her (and her partner if applicable). This appointment allows the doctor to assess the ovaries and womb and determine the best course of treatment. The next stage will be to meet with a nurse at the nurse’s consultation. At this point the patient(s) can discuss which donor sperm is to be used and the nurse can go through our list of sperm donors with you. If you decide to purchase sperm from an external sperm bank this is perfectly fine; however you will have to arrange for the sperm to be couriered to the clinic. The treatment itself is exactly like our other types of IVF: the female patient will take a suitable combination of drugs for several days before having her eggs collected under sedation. These will then be mixed with the donor sperm in the lab before being replaced in the woman’s body a few days later.

    If you plan to use a known donor, he will need to go through a series of stages to assess his suitability. It is best to contact us for more details on using a known donor.

IVF with donor eggs    
  • Do you offer treatment with donor eggs?
       

    Yes, we offer treatment with eggs from UK donors, Spanish donors and known donors. We have our own donor bank to choose from. For people of European descent, we usually do not have a waiting list. We also liaise with a clinic in Spain, so if there are no suitable donors in our donor bank, we can find a donor from the Spanish clinic which has a large selection. If you would like treatment with donor eggs, the first step is to come into the clinic for an initial scan and consultation.

    For more information, please visit Egg Donation

  • What is the process of having treatment with donor eggs?
       

    You will come into the clinic for an initial scan and consultation where the doctor will perform an internal scan to assess your womb and the womb lining. You will then have a consultation where the doctor will go through your medical history and devise a personalised treatment plan. The next step will be to come in for a treatment consultation with a nurse. At this point the nurse will discuss your treatment with you and help to match you with a donor. There are three routes for egg donation: a known donor, a UK donor or a Spanish donor.

    Known donor: For treatment with a known donor, you and your donor will take medication for a number of weeks to synchronise your cycles and to encourage the growth of the eggs in the donor’s cycle. Both of you will also come in to the clinic for monitoring scans. The eggs will then be collected from the donor’s ovaries under sedation and mixed with the sperm in the lab. A few days later the fertilised eggs will be transferred into your womb.

    UK donor: In the nurses consultation you will go through the list of available donors and the nurse will help to match you with a donor. You will then take medication to thicken the lining of the uterus and prepare it for implantation. Doctors will assess the thickness of the lining with scans every few days. Once you are ready for the embryos to be implanted, the donor eggs will be fertilised with your partner’s sperm in the lab and transferred into your womb.

    Spanish donor: After consulting with the doctor you will meet with a nurse and complete donor matching forms in order to find a suitable donor. You will then take some medication to prepare your womb for implantation and come into the clinic for scans to assess the womb lining. Once the womb has been prepared for the embryo transfer you will travel to the IVI centre in Madrid where the male partner will provide a semen sample. This will be used to fertilise the eggs which will then be transferred into your womb.

  • Are the donors anonymous?
       

    In the UK, a law passed in 2005 means that any donor-conceived children, once they reach the age of 18, have the right to identifying information about the donor. Anonymity laws are not the same in Spain, meaning that donors in Spain retain their anonymity.

  • What are the success rates?
       

    The success rates for treatment with donor eggs are very good; more than 50% of patients are successful with this treatment.

IUI    
  • What is the process of Inrtra-Uterine Insemination (IUI) treatment?
       

    The first step in IUI treatment is to come into the clinic for an assessment scan and consultation. At this point the doctor will perform an internal scan. You (and your partner if applicable) will then have a 30 minute consultation where the doctor will go through your medical history and devise a personalised treatment plan. It is recommended that you undergo a tubal patency test in order to ensure that your fallopian tubes are clear and the sperm is able to reach the egg. You will then come in for a number of scans following the start of your period. These will be used to monitor the growth of the follicles and track ovulation. Once the time is right to perform the IUI, the sperm sample will be washed and prepared before the procedure. The IUI procedure involves introducing the sperm to the uterus through a thin catheter at the correct time of the cycle when the egg is being released.

  • Do you have donor sperm available for use in IUI?
       

    Yes, we have a bank of donor sperm at the clinic. You can select donor sperm from this bank or arrange for sperm from an external bank to be transferred to the clinic. If you would like to use a known sperm donor, this can also be arranged. 

    For more information, visit IUI.

ICSI    
  • What is ICSI?
       

    ICSI stands for intra-cytoplasmic sperm injection. This refers to when the sperm is directly injected into the egg, rather than the sperm and egg being put in a dish to spontaneously fertilise.

    For more information, visit ICSI

  • Who is ICSI suitable for?
       

    ICSI is generally used for patients where there is a male infertility factor or fertilisation problems.

  • Do you do PICSI?
       

    Yes, we perform PICSI (Physiological Intracytoplasmic Sperm Injection). This technology allows embryologists to select the most suitable sperm to inject into the egg. The sperm can be tested to see how well it binds to Hyaluronan (HA), which is a naturally occurring substance on the surface of the egg. HA can be coated onto a dish, and the embryology team will chose sperm that bind to it. It has been shown that these sperm are more likely to be mature, mobile and healthy.

Egg & sperm freezing    
  • Why should I freeze my eggs?
       

    Fertility in women declines from the age of 35, and for women who are concerned about ensuring that they have an option of conceiving in the future, egg freezing offers a viable solution. The earlier eggs are frozen the better, as eggs are more numerous and healthy the younger you are. Egg freezing is suitable for anybody who wishes to preserve their fertility, whether because they wish to pursue a career, have not yet found the right partner or have medical reasons for doing so. We freeze eggs using vitrification or fast freezing, a technique pioneered by one of our Scientific Directors R C Chian.

  • What does egg freezing involve?
       

    The process for freezing eggs is similar to that of undergoing full IVF, except that there is no embryo transfer at the end. You will need to come in for an initial consultation with one of our doctors who will assess your ovarian reserve and medical history and suggest the most suitable treatment. You will then take some medication to encourage the growth of the eggs and come into the clinic for scans to monitor their growth. At the end of a week or so, you will come in for your egg collection which will be carried out in the theatre under sedation. The eggs will be frozen following this and can be thawed if you decide to go ahead with any fertility treatment; the survival rate of eggs after thawing is 91%.

    For more information, please visit Egg Freezing

  • What are the success rates with egg freezing?
       

    Around 91% of frozen eggs will survive the thawing process, and the success rates for fertility treatment using these eggs is comparable to treatment with fresh eggs. The age at which the egg was frozen is important in determining future success rates, as younger eggs are healthier. If around 15 eggs are frozen, there is around a 50% chance of having a baby with them in the future (for women under the age of 35).

  • Do you do sperm freezing?
       

    Yes. Sperm freezing is a relatively simple process. Before having the sperm frozen you will need to have some screening bloods taken, for HIV, Hepatitis B Core Antibodies, Hepatitis B Surface Antigens and Hepatitis C. These can be done with your GP or we can perform them at the clinic for £150. You will then need to come into the clinic to fill in some forms produce a sample. Please abstain for 2-5 days before this. The sample will then be frozen by our embryologists using vitrification technology. It costs £150 to freeze sperm.

     For more information, please visit Sperm Freezing

Male infertility    
  • What is male fertility problems?
       

    Male infertility is becoming an increasing problem in the developed world. For couples with infertility problems, male infertility is a contributing factor in up to 50% of cases. It is the sole cause in about 30% of cases.

    Infertility in men can be caused by varying problems including general lifestyle issues, disorders of male (reproductive) organs and genetic disorders.

    When it comes to sperm production, men’s testes are like factories. They are then stored in tightly coiled tube called epididymis, which lies on the side of the testis. Sperm are ejaculated in the semen which comes from prostate and seminal vesicles. Testes produce new sperm every 2 to 3 months.  This means that a man’s lifestyle in the preceding months has an impact on the quality of the sperm sample.

    Modern lifestyle has not helped; as men are now often sitting for long hours at desks, fashion trends towards tight underwear and unhealthy nutrition are all contributing to male infertility problems. However, the good news is that it is widely accepted that men can improve the quality of their sperm by improving general health. Before recommending more invasive treatment, it is always important to try to optimise health to achieve the best sperm quality.

  • What is normal parameters?
       

    For sperm to be considered as healthy it must have a count of 15 million per millilitre of semen, have a progressive motility rate of 32% (speed of movement) and a morphology (shape of sperm) rate of 4%. Note, this means that a man can have up to 96% abnormal forms, but still have a ‘normal’ sperm sample, as long as the other parameters are met.

  • Lifestyle factors
       

    The common lifestyle choices that affect the quality of sperm are:

    • Obesity
    • SmokingExcessive alcohol consumption
    • Recreational drugs.
    • Increased scrotal temperature
    • High stress levels

     By cutting out unhealthy aspects of lifestyle, it is possible to improve male fertility and the chances of conception.

  • Specific problems
       

    There are specific problems that can lead to male infertility. These include issues such as undescended testis, testicular tumours, varicoceles (prominent veins), blockage of the ejaculatory ducts, sexually transmitted diseases, chemotherapy for cancer, some medications and chromosome abnormalities such as Klinefelter syndrome.

    One of the most severe forms of male infertility results in azoospermia where no sperm appear in the seminal fluid. This is of two types: obstructive and non-obstructive. In the former, there is obstruction to the passage of sperm due to congenital, surgical (vasectomy) or previous infection. In the second type sperm production in the testis is impaired  or damaged. This condition may be amenable to aspiration of sperm from the testis (testicular sperm aspiration-TESA) or extracting the sperm from the testis (testicular sperm extraction-TESE). In men with obstructive azoospermia it is often possible to aspirate the sperm from the epididymis (percutaneous epididymal sperm aspiration- PESA) with a needle.

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If you have a specific question not answered below please contact our friendly team of fertility experts who will be happy to help.

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