At the Agora we offer a range of treatments for patients and their partners. You will be offered a specific treatment programme depending on your initial fertility screening results, your age (and that of your partner), your overall health and how long you have been trying to become pregnant. We use an ‘electronic witnessing system’ which matches each patient and their partner (or donor) with a number and barcode that is also used to tag their sperm or eggs. This unique numbering and barcode system ensures that mistakes cannot be made.
Ovulation induction (follicle tracking)
Some women have irregular menstrual cycles and don’t produce an egg each month. This is called anovulation, and is usually due to the woman having polycystic ovary syndrome (PCOS). Other causes include stress, weight loss or weight gain, or excessive production of a hormone called prolactin, which stimulates milk production in the breasts. Anovulation is the commonest cause of infertility and the easiest to treat. Ovulation induction aims to restore ovulation in the most natural way possible.
What does it involve?
Ovulation induction involves the woman taking fertility drugs, either in the form of tablets or injections, to help the ovaries produce and release a single egg each month. Injections are only used if there is no response to the milder tablets that are prescribed. The way that you respond to taking the medication is monitored with a series of transvaginal ultrasound scans in the first half of the cycle (follicle tracking) and a hormone blood test for progesterone seven days after ovulation.
To find out more, you can download our patient information leaflet about ovulation induction.
Intrauterine insemination (IUI) using partner or donor sperm
IUI is the simplest form of assisted conception (help with becoming pregnant) and involves the injection of specially prepared sperm into the womb. It is essential to know that the fallopian tubes are open (patent) and healthy before this treatment is recommended, so you will usually be advised to have a tubal patency test first.
An IUI treatment cycle can be natural (without medication) or medicated using injections that boost egg production. The insemination itself is timed to correspond with ovulation so that you have the best possible chance of becoming pregnant.
What does it involve?
The procedure is similar to having a cervical screening test. During a speculum examination a fine catheter is passed through your cervix to allow the sperm to pass directly into the womb. To find out more, you can download our patient information leaflet about IUI.
In vitro fertilisation (IVF)
In vitro fertilisation (IVF), which literally means ‘fertilisation in a glass’, has resulted in the birth of many ‘test tube babies’. During the procedure, which is carried out in our on-site laboratory, eggs which have been removed from the ovaries are fertilised with sperm in a specially designed incubator, and then grown in the laboratory for two, three or five days before being placed back in the womb. IVF is recommended if:
- You have blocked, damaged or absent fallopian tubes
- There are sperm abnormalities
- You have not become pregnant using medication or other techniques such as IUI
- You have unexplained infertility
What does it involve?
There are a number of different treatment methods used in IVF and, having carried out your initial fertility screen, your consultant will be able to advise which one is best suited to your ovarian profile. However, all IVF cycles involve the need to have hormone injections to boost the production of eggs and prevent natural ovulation. The eggs are then collected and fertilised using either your partner’s or donor sperm. Your consultant will be able to discuss the details of your treatment with you and answer any questions you may have.
- Preventing natural ovulation
The first step in IVF treatment is having medication that stops your normal menstrual cycle. This usually involves injecting yourself every day for around 14 days, or using a nasal spray.
- Boosting egg production
Once your menstrual cycle has been prevented, the next step is to inject a fertility hormone known as follicle stimulating hormone (FSH) daily for about 12 days. This boosts egg production, which means there will be more embryos to choose from to implant in the womb.
- How we monitor your progress
You will have regular appointments at the Agora to check your progress using transvaginal ultrasound scans and blood tests.
You will also be given medication to help your eggs to mature around 35-38 hours before they are collected.
- Egg collection
Eggs are collected using a fine needle under ultrasound guidance while you are sedated. You may experience some cramping and/or light bleeding afterwards. You will be given medication (pessaries, injections or gel) to prepare the womb lining (endometrium) for the embryo to implant (attach). To find out more about egg collection you can download our patient information leaflet.
The eggs are fertilised using either your partner’s or donor sperm. They are then developed in our on-site laboratory for up to 20 hours before being checked. If they have been fertilised, the embryos are kept in our incubator for a few more days, after which the best ones are selected for transfer.
- Embryo transfer
If you are under 40, one or two embryos can be transferred. If you are 40 or over, you may have as many as three. However, the number that is transferred is usually kept as low as possible to avoid risks including multiple pregnancies. We offer embryo freezing and frozen embryo transfer so that you can store embryos that are not implanted for future IVF treatments.
To find out more, you can download our patient information leaflet about IVF.
Male partners will be asked to provide fresh sperm at about the same time their partner’s eggs are collected. The healthiest sperm are selected following a special process that is carried out in our on-site laboratory. Donor sperm, which has previously been frozen, is prepared using the same process. In some cases, surgical sperm retrieval may be offered.
Surgical sperm retrieval
Where there is a low sperm count or the tubes within the testicles are blocked, damaged, or absent, surgical sperm retrieval can be carried out. There are two methods for this and both are carried out under a light general anaesthetic with an additional local anaesthetic to reduce pain after surgery:
- PESA (percutaneous epididymal sperm aspiration) – when sperm are collected from the epididymis (where they are stored after they have been made in the testes), using a fine needle
- TESE (testicular sperm extraction) – when a biopsy is taken from the testicular tissue in order to remove some sperm. This involves making a small cut in the scrotum
Intracytoplasmic injection (ICSI)
ICSI is a form of IVF in which a single sperm is injected into an egg, which is then transferred into the woman’s womb and means that, even if sperm numbers are very low, it may be possible to fertilise an egg. The procedure is carried out in our on-site laboratory using a specially adapted microscope. ICSI is advised for couples where the sperm quantity or quality is very poor, or when IVF has resulted in failed fertilisation. It is also used when the sperm has been collected by surgical sperm retrieval. For more information, you can download our patient information leaflet about ICSI.
Intracytoplasmic morphologically selected sperm injection (IMSI)
IMSI is similar to ICSI except sperm is examined using greater magnification. This enables our embryologists to identify sperm defects that may not be visible with conventional ICSI.
Embryo freezing (vitrification)
Following an IVF or ICSI treatment cycle there may be some embryos, usually at the blastocyst stage (where an embryo has developed for five to six days after fertilisation), which are suitable to freeze. We use state-of-the-art vitrification technology to freeze embryos, which are kept in liquid nitrogen storage at -196°C. At this temperature all biological activity in the embryo stops and the embryos will be stable for many years. Current regulations allow us to store embryos for up to 10 years. These embryos can be used at a later date in frozen embryo transfer cycles. To find out more about embryo freezing, you can download our patient information leaflet.
Frozen Embryo Transfer (FET)
FET is when eggs that have already been collected, fertilised and frozen in our on-site laboratory are transferred into the womb; the embryo then needs to attach itself to the wall of the womb in order for the pregnancy to develop.
The management of FET cycles is simpler and cheaper than fresh cycles because IVF stimulation medication is not required. If you have a regular cycle, the embryos are transferred soon after ovulation. If you do not have ovulatory cycles, or the cycle is irregular or absent, the embryos are transferred during an artificial cycle using hormone replacement therapy (HRT) to build up the lining of the womb.
In general, three out of four good quality embryos survive the freezing and thawing procedures. However, success rates depend on the development of the lining of the womb (endometrium) and on the quality of the embryos frozen. The embryologist will discuss your individual requirements, advise on the quality of your embryos, and discuss the chances of success. For more information about frozen embryo transfer, you can download our patient information leaflet.
Advances in the way we are able to grow embryos in our laboratory now mean that we can grow the blastocysts for longer, making it easier to select embryos with more potential. This can help improve the chances of pregnancy after a single embryo transfer, although other factors can also affect success rates, including the condition of the lining of the womb (endometrium), the age of the patient and the outcome of previous cycles.
Our success rates for blastocyst transfer are close to 60% for women aged 37 and under. And, by reducing the number of embryos that we transfer, this also reduces the risk of a multiple pregnancy. To find out more about blastocyst transfer, you can download our patient information leaflet.
Donor insemination is intrauterine insemination (IUI) using donated sperm. There are many reasons why you may require donor sperm, which can usually be used with IUI provided you have patent (open) fallopian tubes. This can be discovered using a tubal patency test.
When donor insemination is carried out, your treatment cycle can be natural (without medication) or using hormone injections to boost egg production. The insemination itself is timed to correspond with ovulation so that you have the best chance of conception, and the procedure is similar to having a cervical screening test.
Risks of infertility treatment
You will be able to discuss the risks of any specific treatment with your consultant at the Agora. However, we aim to minimise the risks associated with all fertility treatments that we offer.
Fertility drugs taken throughout any form of treatment cycle can cause immediate side effects such as headaches, loss of appetite, feeling sick and hormonal changes such as hot flushes. Although in most cases your symptoms will improve after a short time, you should see your doctor as soon as possible if they continue, or you are worried about any aspect of your health.
Ovarian hyperstimulation syndrome (OHSS)
OHSS can be a serious over-reaction to the fertility drugs that are used to stimulate the ovaries during IVF cycles. Despite careful monitoring at the clinic, which includes scans and blood tests, a small number of women can over-respond to their hormone injections by producing an excessive number of eggs. This can result in side-effects, including stomach pains and feeling sick, and your ovaries may also feel uncomfortable and enlarged. It’s important to contact the Agora straight away if you experience any of these symptoms. You will be given our emergency mobile number so that you can contact our on-call team if you experience worrying symptoms out of hours.
If you are showing signs of OHSS you will be monitored using pelvic ultrasound scans and blood tests and in some cases you may need to go into hospital so your condition can be monitored if your symptoms become worse.
Multiple pregnancies (ie, carrying more than one baby) are the biggest health risk of having fertility treatment. Carrying more than one baby is common following stimulated IUI, IVF or ICSI and is an important consideration for all patients because it involves an increased risk to the mother during and after pregnancy; it can also cause problems for the developing babies. Risks include miscarriage, high blood pressure, gestational diabetes, premature labour and caesarean section or delivery with forceps. The risks to the developing babies include being born too early (prematurity), low birth weight and cerebral palsy.
In cases where women are at a higher risk of a multiple pregnancy following IVF or ICSI (for example, younger women) we usually advise them to have only one embryo replaced at the time of transfer. In IUI treatment, we aim to avoid multiple pregnancies by following your natural cycle rather than giving you medication to boost egg production, especially for women who are at greater risk.
If a multiple pregnancy is confirmed at the time of your seven-week scan, you will be offered a second scan at nine weeks before having routine follow-up appointments under NHS obstetric care.
An ectopic pregnancy is when a fertilised egg implants and develops in one of your fallopian tubes instead of in the womb. This can happen after natural conception or IVF. We will usually arrange for you to have an early pregnancy ultrasound scan to check for any problems around three weeks after your positive pregnancy test following IVF treatment. However, you should contact us, or your own GP, immediately if you are worried about any aspect of your health. For more information about ectopic pregnancy, you can download our patient information leaflet.