REFERRAL
Most couples are referred by their General Practitioner, local Gynaecologist or Urologist. Providing you satisfy the local social criteria set by the Local Health Boards and Health Commission Wales (HCW), you can be considered for NHS treatment. The waiting time for a new NHS appointment is up to 26 weeks.
Alternatively, you may prefer to undertake your treatment as funded patients, which can speed up your appointment time.
We are happy to see heterosexual couples and same sex couples, and may consider self funded treatment for women up to 45 years.
In all couples, the welfare of the child has to be considered (see the HFEA website). At your first visit you will be asked to complete a questionnaire to ensure that if a baby is born as a result of our treatment, there will be no social or medical reasons why you cannot care for him or her. Also at your first visit, we will ask for your permission to inform your GP and other essential personnel of your treatment. It is important that you bring some form of identification with you so that it can be checked before the consultation takes place.
STEPS TO TREATMENT
Your initial consultation at IVF Wales is the beginning of our process of getting to know you, gathering more information about your condition(s), and starting to develop an individualized treatment plan.
At your initial consultation:
- you will meet an IVF Wales doctor and other members of your care team
- you will be able to speak extensively with the team about the length of your infertility and your fertility history
- we will review your medical, surgical and family histories
- we can, if necessary, determine which simple tests will provide an accurate diagnosis
- we will begin to derive a comprehensive and individualized treatment plan
- we will answer any questions you may have about infertility, fertility treatment or your personal case.
INVESTIGATIONS
In all couples we need to check:
- Whether the ovaries are making eggs - and if not why not. This involves hormone blood tests and a scan.
- Whether the testes are making sperm - and if not why not. This involves a semen analysis.
- Whether the woman’s womb and ovaries are normal on an ultrasound scan.
- Whether the fallopian tubes (the place where the sperm and eggs meet) are open. This can involve either a special scan (hycosy scan), an X ray (hysterosalpingogram) or sometimes a small operation called a laparoscopy.
It may be possible for you to do some of the blood tests with your GP, but the sperm tests and the scans need to be done here at IVF Wales.
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| Hysterosalpingogram | Hycosy |
FURTHER INFORMATION ABOUT THE TESTS
Hormone Tests
We usually measure 2 hormones that come from a gland in the brain at the beginning of you cycle (day 1-3), which tell the ovary to start making a new egg. These are called Follicular Stimulating Hormone (FSH) and Luteinising Hormone (LH). Abnormalities in these hormones can be helpful in looking at ovulation problems.
We often also measure a hormone called Progesterone which is produced by the ovary after ovulation – typically reaching a peak on day 21. This tells us if your ovary has produced an egg that month.
We are also interested in knowing how many eggs are left in your ovaries, so we perform a blood test called Anti-Mullerian Hormone (AMH). The results will give us information about the quantity but not the quality of the eggs.
Semen Analysis
Please refer to the information on Semen Analysis.
Ultrasound Scans
Almost all our scans are performed transvaginally. This ensures that we are as close as possible to the structures that we need to see, and means that you do not need a full bladder. This is usually not uncomfortable, but if you have problems with cervical smears you should let us know.
Tubal Tests
Tubal Tests
Tubal tests are only undertaken if we are considering treatments that require the tubes to function normally, eg clomiphene or intra uterine insemination. Because the tubes cannot normally be seen on scan, the tests all require a fluid that shows up on scan or X Ray to be flushed through the tubes to demonstrate that they are open. This can be a bit uncomfortable and cause some period type cramps. We do not suggest this test if, for example, the sperm count is low; in this situation we would be suggesting intracytoplasmic sperm injection (ICSI), which does not need your tubes to be open. The sperm test therefore needs to be done before any tube tests. Currently we only perform the test for Cardiff residents.
Laparoscopy
Laparoscopy is a procedure which is done in the operating theatre under a general anaesthetic, where a telescope is introduced into your abdomen in order to look around your pelvis. Because it is more invasive than the scan and X Ray alternatives, it is usually reserved for those women who have pain which needs investigating, or endometriosis that needs treating. You will be referred to your local Consultant Gynaecologist for this procedure.
FERTILITY ENHANCING PROCEDURES
Several procedures can be performed prior to or as part of fertility treatment to expand the options available and/or improve your chances for achieving a successful pregnancy.
Laparoscopy
Laparoscopy is an effective means to diagnose or treat anatomical infertility problems. It is a minimally invasive surgical procedure that allows physicians to clearly view the condition of the pelvic organs. It is used to treat:
- Endometriosis (chronic condition where normal tissue found in the uterus grows outside the uterus)
- Ovarian cysts (fluid filled sac inside the ovary)
- Correction of scar tissue and adhesion formation
- Fibroids (benign muscle tumors) from the outer surface of the uterus
- Ectopic pregnancy (embryo implants outside the uterus)
- Blocked or damaged fallopian tubes.
Performed in an outpatient surgical setting, laparoscopy usually takes between 30 to 60 minutes and requires general anesthesia. Technological advancements in laparoscopy enable IVFWales surgeons to perform delicate, specialized surgery in a minimally invasive, patient friendly manner.
Hysteroscopy
Hysteroscopy is a minimally invasive surgical procedure that is used to diagnose and treat abnormalities of the uterus. Hysteroscopy is used to successfully treat:
- Fibroids (benign muscle tumors) on the inner surface of the uterus
- Endometrial polyps
- Uterine abnormalities such as scar tissue
- Abnormally heavy uterine bleeding
- Repair of uterine septum.
A hysteroscopy is typically performed on an outpatient basis in an operating room under general anesthesia. It is minor surgery that requires no incisions. In some instances, it can also be performed in a doctor’s office with local anesthesia and only minimal discomfort. Most women are able to resume normal activities immediately following a hysteroscopy.
DIAGNOSIS
DIAGNOSIS
Once all the investigations are finished we should be able to make a diagnosis and tell you what the problem is. Sometimes we cannot find anything wrong, and in this situation we make a diagnosis of 'unexplained infertility'. At this point we can suggest what treatments will be most appropriate for you and talk about the pros and cons of the options. If you are eligible for NHS treatment, we can put you on the list.
