HOW TO GET STARTED
Make An Appointment
The first step is usually the hardest – making that initial call. But remember, you are not alone; simply phone us in the strictest confidence and one of our friendly team will help guide you through the options open to you. Whether you have recently become concerned about your fertility or looking for a second opinion we will do our best to help you achieve a successful outcome.
We can generally offer an initial consultation within a few days, and for your convenience we offer appointments Monday to Friday from 10am to 10pm as well as Saturday and Public Holiday appointments.
So the first step is to come into the clinic for an initial consultation. All of our patients require a consultation before they start any treatment with us. This is a chance for the specialist to meet you, discuss your medical history, advice you on your fertility and start to plan your treatment. During the consultation the female partner will have a pelvic ultrasound scan and where applicable the male partner will need a semen analysis.
We welcome first-time patients, as well as those who have tried fertility treatments at other clinics.
Pelvic Ultrasound Scan
Our consultant will perform a pelvic ultrasound scan of your womb and your ovaries on the day of your consultation. The ultrasound will detect any cysts or polyps that may cause any problems with your fertility. The ultrasound probe (covered with a sterile probe cover) is placed just inside your vagina.
The scan does not take long and is not usually painful. You do not need to attend with a full bladder unless you are unable or uncomfortable to have an internal scan. It is also important that you tell us if you are allergic to latex rubber.
Semen Analysis
Prior to the consultation, we would suggest that the male partner has a semen analysis. The analysis will test for
- the number of sperm present
- the number of sperm that are moving (motility)
- the number of sperm that are normally formed (morphology)
- whether there are anti-sperm antibodies present (MAR)
- whether or not an infection is present in the sample
The male partner will need to abstain from any form of sexual contact for three days (no more, no less) before the semen analysis takes place.
Consultation with the specialist
You will meet with our experienced consultant who is a specialists in fertility, gynaecology and IVF. The consultant will complete a detailed review of you and your partner’s (where applicable) medical history and discuss your pelvic ultrasound scan results and semen analysis report. If you have have test results or treatment notes from previous clinics that are relevant to your future treatment, we would suggest that you bring these along to your consultation for the specialist to review.
Following the review of your medical history and results, the specialist will advise you on your fertility and the treatment options that you may need to consider and discuss these with you in detail. This is a good time to ask any questions that you might have about your results and the treatments you have been recommended. We understand that a large amount of medical information may be overwhelming and difficult to comprehend so the specialist will do their best to help you understand your results and the treatment options available.
Patient Treatment Pathway
Getting Started: We appreciate that being concerned about fertility can be worrying. As dedicated fertility specialists we see patients from all walks of life with differing problems – those who seek our advice because they have only recently become concerned about their fertility, and those who have had treatments elsewhere and need a fresh view.
The first step is to book an initial appointment with us.
Call our fertility helpline at 010-7778901 and ask for Vanessa.
Information: If you need further information or support at any time, we are happy to help. Please feel free to request a brochure or more specific information packs.
Additionally we hold regular information evenings where you can meet the staff, have a look round the unit and ask questions.
Please feel free to call our centre to discuss how we can help.
As you’d expect, we’ll discuss your medical and surgical history and talk about relevant options that are available to you. If you need further tests or examination, we’ll try to perform it there and then. We want to minimise your journey and waiting time and will not request unnecessary tests and will use any up to date information you have. Arrangements will be made to check a semen sample because this helps to form an early view of the appropriate course of treatment. All of these aspects will be taken into account to personalize your treatment.
To help improve the likelihood of success, drugs are used to stimulate your ovaries, this increases the number of eggs you produce.
We have many different regimes so that we can tailor therapy to your specific needs. In general, the stimulation drugs are administered daily, by injection. Training will be provided by our staff on how to carry this out.
During the days leading up to egg collection your progress is monitored regularly and closely throughout this stage of your treatment. When tests show that your eggs are ready, there will be another injection to help the eggs mature before collection. The timing of this final injection is important.
Approximately 36 hours later your eggs are ready for collection and the clinic will give you the precise time to attend for egg collection.
Your eggs are recovered using a vaginal ultrasound procedure. This is a straightforward process that takes about 30 minutes, under sedation or anaesthesia and is considered an out-patient procedure. You should be able to go home within a couple of hours. The number of eggs collected varies between patients.
Once collected the eggs are prepared for the next stage by the embryologist.
Collection of Sperm: Your partner is usually requested to produce the sperm sample around the time of egg collection. Some patients may have sperm frozen whilst others might require a surgical sperm recovery, either under sedation or anaesthesia.
The prepared eggs are inseminated on the same day. This can be done in two ways:
IVF, where the eggs are mixed with a specially prepared sperm concentration, then moved to an incubator to fertilise;
or
ICSI (Intra-Cytoplasmic Sperm Injection), this highly skilled procedure involves a single prepared sperm being injected directly into the centre of an egg. The inseminated eggs are moved to an incubator to fertilise.
Fertilisation: Fertilisation occurs when a sperm fuses with an egg, this is checked the day after insemination (Day 1). Successful fertilisation is indicated by the fertilized egg (zygote) having 2 ‘pro-nuclei’ (i.e. it contains two nuclei, one containing the maternal DNA while the other contains the paternal DNA) Zygotes at this stage are known as ’2 PN´s’. Once observed the 2 PN´s are returned to the incubator for further monitoring.
Cleavage: Once the zygote divides into two cells (by the day following fertilisation) embryo development begins. Cleavage is the usual term used to describe the division of cells within the embryo (because for the first five days although the embryo increases in cell number it does not change its mass, but the cells, which get smaller and smaller, are ‘cleaved’ from the original egg mass). Each cell of the embryo has its own developmental programme, so that the embryo might have 2, 3, 4, 5 or 6 cells on the day after fertilisation (Day 2). Therefore, the number of cells on Day 2 is not critical to establishing a viable pregnancy. The quality of these embryos is assessed and graded from 1 to 4 (1 being the highest grade and only 1 or 2 being suitable for freezing). This is particularly important when considering the freezing of embryos.
Embryos are transferred to the womb on either Day 2 or Day 3, or at the blastocyst stage [‘blastocyst transfer’] on Day 5 or Day 6. Following PGD or PGS we almost always use blastocyst stage transfer. The embryo transfer procedure is straightforward and is almost always performed without the need for sedation or anaesthesia.
The HFEA in the United Kingdom only permits the transfer of two embryos except in exceptional circumstances. If three embryos are to be considered for transfer we will need to discuss this very carefully with you.
Soon after transfer a nurse will visit you and explain the next steps, but you will be able to go home soon after.
Assessing the outcome of your treatment is performed in two ways, first the ‘pregnancy test’, which may need to be repeated, and the ‘pregnancy scan’.
Pregnancy Test: This is usually taken 14-16 days after embryo transfer. The test results indicate whether or not an embryo has implanted in the womb. It might be very important to repeat this test and you will be given the necessary advice.
Pregnancy Scan: If the pregnancy test is positive an appointment will be booked for an ultrasound scan to see if a heartbeat is visible to show an ongoing pregnancy. Once this is confirmed you will then be discharged into the care of your GP who will arrange ante-natal care.
If the pregnancy test proves negative, a follow up appointment will be arranged to discuss your future options. Support counselling is, of course, always available.
Fertility treatments
Ovulation induction
When ovulation (release of an egg by the ovary) is not occurring regularly, ovarian stimulation can be used to increase the chance of an egg being produced in a cycle. Hormones identical to those in your body are used to increase the growth of follicles that develop fully to produce eggs. Your stimulated cycle is monitored by blood tests and ultrasound, and ovulation may be initiated by an injection (hCG). Couples will be advised when is the best time to have intercourse.
The chance of a multiple pregnancy increases using this method of assisted fertility. The likelihood of twins is approximately 10 – 20% with each pregnancy. This may not suit your personal circumstances or not be medically appropriate. A cycle may be cancelled if it appears that too many follicles have been produced or it may be recommended that a couple proceed to IVF treatment.
IUI Treatment Stages
What happens in an IUI cycle?
IUI involves placing prepared sperm directly into the woman’s womb via the cervical canal close to the time of ovulation. There are two types of IUI which your specialist can discuss with you and then advise you on the most appropriate type for your case. Natural IUI means that you do not need to take any medication whereas stimulated IUI requires you to take medication to stimulate your ovaries prior to your insemination procedure.
Three cycle IUI package
Here at the Subang Jaya Fertility our aim is to make treatment less stressful and more affordable.
Results worldwide demonstrate that success rates improve when treatment is undertaken as a course of treatment and not as a one-off attempt.
Fertility treatment, when charged on a cycle-by-cycle basis, may prove an expensive approach the three-cycle package offers three treatments for the price of two. Response to the idea has been tremendous and success rates are good.
We have found that patients are more relaxed from the outset if they know that they have further opportunities for pregnancy. And our results show without doubt that the ‘cumulative’ rate of success is always higher than that from one cycle.
The three cycle IUI package can be undertaken on both natural and stimulated cycles. Please contact the clinic for more details.
IUI Treatment Stages
IVF is the original ‘test-tube’ baby technique, involving the fertilisation of eggs by sperm outside the body. It was developed more than 30 years ago for the treatment of women with damaged fallopian tubes, and this remains an important reason for treatment today. However, it is also used in cases where a woman has endometriosis, the male partner has poor quality sperm, or when the cause of infertility is unknown.
What does IVF treatment involve?
IVF treatment consists of a sequence of procedures known as the ‘treatment cycle’.
Hormone therapy is used to stimulate the development of several follicles in the ovary. These are collected as eggs, which are then fertilised in a test-tube (‘in vitro’) to create several embryos.
After two to three days in an incubator, at the two to eight cell stage, the embryos are carefully checked using a well-established grading system.
The best one or two are transferred through the vagina to the uterus, where it is hoped that implantation will occur so that pregnancy can begin.
In some cases, the alternative to embryo transfer on day 2 or 3 is blastocyst culture and transfer.
A blastocyst is a more highly developed embryo that has divided many times into a large number of cells. An embryo reaches this advanced stage of development on day five or six following insemination.
Blastocyst culture enables us to maintain, or even increase, IVF success rates for our patients whilst significantly decreasing the risk of multiple pregnancies (twins or triplets).
However, in IVF as in natural conception, not every embryo implants to become a pregnancy, which is why surplus embryos are sometimes frozen – so that a subsequent transfer might be tried if the first one fails.
Intracytoplasmic sperm injection (ICSI)
ICSI is an advanced microsurgical fertilisation technique available for the treatment of male infertility. It is used in conjunction with IVF and involves an extremely precise microscopic surgical procedure on an egg to assist fertilisation.
ICSI can be used in situations where the male partner produces only a very small number of sperm that are incapable of penetrating the barriers surrounding the egg unassisted.
This is usually because the sperm have extremely poor movement (motility) or no movement at all. ICSI is also used when sperm is directly retrieved from the testes using PESA or TESE.
Your treatment will be overseen by a team of professionals working together to provide a seamless journey from the moment you book your initial consultation and we will do the utmost to make sure your treatment is stress free.
