IVF Wales - Your Pathway to Treatment

YOUR PATHWAY TO INFERTILITY TREATMENT AT IVFWALES

REFERRAL

Most couples are referred by their General practitioner, local Gynaecologist or Urologist, and this is generally a good idea as often they can send results of the tests that you may already have had, to speed up your treatment and avoid having to repeat anything. It also means that providing that you satisfy the local social criteria set by the Local Health Boards and Health Commissioning Wales (HCW), you can be considered for NHS treatment. The waiting list for a new NHS appointment is currently 3-4 months.
Alternatively you may prefer to self refer as self funded patients – this can speed up your appointment time and it is still a good idea to bring along any test results that you may have had elsewhere.
We are happy to see heterosexual couples and same sex couples and will consider treatment for women up to 45 years, although if you are older than 42 the options may be limited due to the problems of obtaining good quality eggs.
In all couples, the Welfare of the Child has to be considered (see HFEA website www.hfea.gov.uk), and this involves a questionnaire which you complete at your first visit, 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 be asking for your permission to inform your GP and other essential personnel of your treatment.

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 IVFWales.

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.

SEMEN ANALYSIS
The sperm test should be booked with our reception (02920 742676) at a time that suits you and suits the laboratory - this means that we know that the specimen is arriving and we can check it straight away. If you live less than an hour away then you may prefer to do it at home and you will need to collect a labelled pot to do it in, alternatively you may prefer to use our men’s rooms if you live further away. All specimens should be produced by masturbation and the best count is obtained after two to three days abstinence from intercourse. If the first result is abnormal then we will usually ask you to repeat it and then suggest that you come back to the clinic for results and discuss treatment.

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 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 them to demonstrate that they are open. This can be a bit uncomfortable and cause some period type cramps - for this reason we do not suggest this test if for example the sperm count is low, as in this situation we would be suggesting ICSI which does not need your tubes to be open. It follows therefore that the sperm test needs to be done before any tube tests.

LAPAROSCOPY
                                                                                                                                                   Laparoscopy is a procedure which is done in 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.

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.

NHS TREATMENT WAITING TIMES
IVF and ICSI treatments have been arranged with us by the Welsh Assembly Government (HCW) since 2005, and they have asked us to keep the waiting time to 12 months except in exceptional circumstances (eg cancer treatment).
IUI treatments are arranged with us by your local health board (LHB)and the waiting times vary according to the demand from your area and the number of treatments that your local LHB wish us to do for them.