For couples with fertility problems, trying to start a family can be a very distressing time. The fact that one in seven couples need medical assistance of some sort may not be of direct comfort when you are suffering yet another disappointment, but it does mean that a great deal of research is being done into infertility, and there are experienced specialists ready to help you through the process. Your first step is to see your GP who will then recommend a specialist, such as female gynaecologist Miss Amanda Tozer, to investigate the cause.
What will happen at the initial fertility consultation?
Before undergoing any tests at Amanda Tozer’s London fertility clinic, you will first talk about your medical history. Miss Tozer will then conduct a physical examination and run several diagnostic tests. These may include: semen analysis; a pelvic ultrasound to check for abnormalities such as fibroids; tubal patency tests whereby the Fallopian tube is checked for any blockages that would obstruct the egg’s movement from ovary to uterus; hormone tests to check ovulation and for imbalances; and saline sonography. Saline sonography is a means of detecting uterine abnormalities and is conducted using a transvaginal catheter through which saline is injected; the saline distends the uterine cavity, allowing abnormalities to become visible on the ultrasound. The results of this test are available immediately.
Individualised care in fertility treatments
A highly experienced female gynaecologist, Miss Amanda Tozer has helped many couples who have had repeated setbacks in either getting pregnant or carrying a baby to term. At her London fertility clinic, couples receive specialist, attentive and personal care; Miss Tozer personally conducts the tests, she talks through each step of the process at length and encourages her patients to ask questions no matter how small – and she can always contacted via her personal phone.
Fibroids are benign growths in the womb and are extremely common: an estimated one in four women will have fibroids at some stage in their life. However, many women will not know they have fibroids as only one third of cases present symptoms; these can include heavy and prolonged periods, swelling, post coital bleeding and infertility. They vary both in size – from that of a small pea to a large grapefruit – and location, the most common of which is within the muscle tissue of the womb (intramural fibroids).
Surgery is not always necessary
Fibroids do not always cause symptoms or they may only be mild; if this is the case, you may not require any treatment. Furthermore, fibroids tend to shrink after the menopause and symptoms ease. There are also medication options to manage the symptoms.
Fibroids and fertility treatment
During your consultation at Miss Amanda Tozer’s London fertility clinic you will initially undergo an ultrasound scan; sometimes an MRI will be required to locate and establish the size of multiple fibroids. Miss Tozer, a female gynaecologist with many years’ experience of treating fibroids, will then discuss the results with you, explaining the implications, if any, regarding your fertility. If the fibroids lie in the muscle tissue (intramural) and are smaller than 5cm, it is unlikely that removal will be recommended.
However, larger intramural fibroids can be removed either in an open procedure or laparoscopically, depending on their location. If Miss Tozer identifies fibroids growing from the inner wall into the middle of the womb (sub mucosal fibroids) she will most likely recommend they be be resected before you embark on fertility treatment. Resection of sub mucosal fibroids entails a hysteroscopy, usually performed as a day case; in some cases, pre-op suppression of hormones will be required.
At the London Clinic, Miss Amanda Tozer’s patients can count on attentive and specialist care.
When a couple has successfully overcome the first stages of the IVF process, a failure at implantation can be devastating. For couples who have had repeated failures despite highly rated embryos, the chances of pregnancy may be improved by a process known as ‘endometrial scratching’. It has been shown in several randomised studies that this procedure of performing endometrial biopsies, usually during the luteal phase (after ovulation) of the menstrual cycle, can improve the rate of implantation, pregnancies and live births.
How does endometrial scratching work?
Endometrial scratching has been widely offered since 2003 but why it is effective is still not clearly known. The belief is that ‘injuries’ to the endometrium (the womb lining) stimulate the production of endometrial white blood cells, creating an inflammatory reaction that in turn enhances the uterus’s receptivity to implantation. Female gynaecologist Miss Amanda Tozer offers endometrial scratching at her London fertility clinic where it takes not more than 15 minutes. It can be uncomfortable and some women may find it painful; it is advisable to take analgesia such as ibuprofen an hour or two before the procedure – your doctor will advise you on this. It is also a good idea to bring a friend or your partner so they can escort you home afterwards.
How much does it cost?
If you are an existing patient of Miss Amanda Tozer, endometrial scratching will cost £100. The procedure is available to any patient, whether or not they are undertaking their IVF treatment with Miss Tozer; for these new patients, the price is £125. Miss Amanda Tozer is an experienced female gynaecologist who offers her London fertility patients expert and individualised support and guidance through this most difficult of challenges; she will talk you through the theories and practicalities of the procedure and its success rates, while ensuring you understand any associated risks or side effects.
Intracytoplasmic sperm injection (ICSI) is part of an in vitro fertilisation requiring only one sperm which is directly injected into the egg. As the sperm neither has to travel to the egg nor penetrate its outer layers, it can help many men with fertility problems conceive with their partners when other options are not open to them.
When will ICSI be recommended?
Your fertility consultant may suggest ICSI if fertilisation has failed in previous IVF cycles, or if the fertilisation rates have been poor with fewer than 25% of mature eggs being fertilised. It is also the preferred choice where the male sperm count is low, has a low number of normal forms or displays poor motility. ICSI is also an option if a man is unable to get an erection and/or ejaculate as the sperm can be taken from the epididymis or testicle under local anaesthetic using a fine needle.
What are the advantages and disadvantages of ICSI?
During a consultation with London female gynaecogist Miss Amanda Tozer, you will talk through all the pros and cons of ICSI. The primary advantage is that it gives some couples the best chance of conceiving a child where previously their only alternative might be a sperm donor. Another benefit is that sperm can be extracted if necessary; it is not at all uncommon for anxiety to prevent ejaculation on the day. In terms of disadvantages, the increased risks of multiple births and ectopic pregnancies are similar to those associated with standard IVF.
Another important consideration is the quality of the sperm: when a couple naturally conceive, only the strongest sperm make it through the egg’s outer layers.
At her London fertility clinic, Amanda Tozer will talk you through the associated risks and share the latest findings from on-going studies and advise you on pre-treatment screening for genetic problems.