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 Hull & East Riding Fertility 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 who have reached their 46th birthday.   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 appropriate  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.   Check your BMI here

If you have any questions about our selection criteria, please feel free to contact us.  Please note, if you are accessing funded treatment at Hull & East Riding Fertility, you must meet the criteria set by your Clinical Commissioning Group.  For more information please see: Do you meet the criteria?

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 regimens will suit you best.

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

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.   If you are non-immune and develop Rubella during a pregnancy, this may have serious implications for your baby.

Screening for HIV and Hepatitis B and C:  Before treatment can commence, both partners must be screened for previous exposure to Hepatitis B, Hepatitis C and HIV infections.   If any of these results are positive, you may require further testing.  Based on these results we will be able to advise what treatments we can offer.   If we are unable to treat you, we will be able to arrange a referral to one of the two specialists units who can.   We can also offer appropriate counselling, and referral to the local infectious diseases service if appropriate.

Chlamydia screening:  Chlamydia is a micro-organism which can lead to damage of the fallopian tubes.   To see if you carry this organism we test 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, which will tell us if you have ever had an infection.

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.  We need to have a copy of your most recent smear test in your notes at the time of your treatment.   This might simply be a copy of the letter you receive advising you of the result.

Semen evaluation:  Although you may have had a Semen Analysis carried out recently  we may still require this to be repeated.  If we think you need some form of IVF we will require a sample to be produced on site, which is subjected to a  more detailed analysis which allows us to  determine which  treatment options are available for you.    (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 miscarry 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 the abdominal 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 they may be blocked.  If any other disease such as endometriosis is found this can 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), fibroids in the wall of the  uterus, or polyps within the cavity of the uterus.

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

We may also perform a scan early in your cycle to determine the number of follicles beginning to grow.   This is referred to as an antral follicle count, and may help us determine the correct dose of stimulation drugs for you.

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 to contact us .

Keeping yourself healthy

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

• Stop smoking, including substitutes such as vaping.
• Reduce alcohol consumption to within government guidelines, although it is best to stop drinking alcohol at all when trying to conceive.
• Eat a healthy, balanced diet.
• Reduce caffeine consumption to a maximum of 150mg daily.

We also strongly recommend that the female partner takes a daily folic acid supplement. The dose of the supplement should be 400mcg (unless you are taking anti-epileptic drugs, in which case the dose of folic acid is 5 mg.    Taking folic acid helps to reduce the risk of your baby being affected by some birth defects, such as spina bifida.

Ladies should also take Vitamin D, Vitamin B complex, Zinc and L-Carnatine.   These are available in many, readily available pre-pregnancy supplements available in your local chemist.

There is some evidence that taking Omega 3 and Omega 6 supplements can help fertility.

We can provide a supplement in the Unit called Proxeed, which has forumulations for both male and female partners, and can also be purchased online.

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 and that a support network exists to support you and your child if you suffer any significant illness.  Before treatment is offered we will need a social report and a counselling report which may be discussed by the Unit Ethics Committee who will advise your Consultant whether they think there are any concerns, which may affect the Consultants’ decision to offer treatment . For more information about options for single women, please do not hesitate to contact us.

Patient Photographic ID verification and Photographs.

Prior to you receiving treatment, usually at your initial or follow up appointment,  we will have asked you to bring in a copy of your photographic ID for us to copy and verify and we will also take a photograph of yourself and your partner to hold on record in your medical case notes.  This is comply with our regulatory body, the HFEA, Code of Practice.

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 HIU00125; V3 rel doc; patient guide – 22.08.2018

Page Last Modified: 3rd January 2025