Top 10 Questions to Ask Before Visiting a Fertility Clinic

Finding the right fertility clinic before you start treatment is crucial, but with around 90 registered IVF clinics in the UK it can be hard to work out which one is best for you.

If you’re considering going down the IVF route, choosing the right fertility clinic is not a decision to be made rashly. We’ve come up with some useful questions to ask ahead of treatment, and consulted Dr. Ippokratis Sarris at King’s Fertility for some sound advice before you start treatment.

1. What makes your fertility clinic unique?

Clinics will offer different types of treatments depending on what they specialise in and the staff and facilities that they have. It is worth remembering that not all registered clinics will carry out every kind of treatment. If you know that you need or want a certain type of treatment then you will need to ascertain whether a prospective clinic can carry out the procedure, and that they have sufficient experience. Depending on your situation, you may want to look for clinics specialising in complex cases or one’s linked with research hospitals and charities.

Speaking about King’s Fertility, Dr. Sarris explains, “What makes us unique is that we’re the only clinic in the UK owned in it’s entirety by a charity and by the trust. This means money generated is fed back into the charity for research and development in fertility treatment and foetal medicine.

“We’re also associated with King’s College Hospital – and the university – so we can consult even the most complexes of cases, where another clinic may not have turned them away or someone needs a second opinion.”

2. Does that make you more of a first port of call or a last hope?

Just as it is important to do your research before hand, it may also be worth seeking different opinions from fertility clinics and IVF specialists. Many clinics will have a mixed combination of patients who are just starting their journey and those who have consulted other centres and doctors. Additionally, different clinics will specialise in certain areas of fertility and the respective treatments, meaning patients may be referred from other clinics if a more tailored treatment plan is needed.

“[King’s Fertility] is a tertiary referral centre for men with fertility problems, and particularly men who don’t have any sperm at all,” adds Dr. Sarris.

“When [a clinic] is at the forefront of research, you’re also at the forefront of development. We regularly run conferences at symposia, for example on genetics and fertility, and a therefore often the first to know about new treatments and tests. You also tend to become the first adopters of new techniques and cancel out bad practice.”

kings-fertility-clinic3. Is your treatment tailored for each individual patient?

Some clinics may only offer a blanket IVF treatment to patients and in some cases this may not be the treatment that works best for certain conditions, such as endometriosis or polycystic ovary syndrome (PCOS). Remember that no one person and their situation are the same, so ensure your chosen clinic will offer you a treatment programme that is personalised to your needs.

“[At King’s Fertility] we also do a lot of fertility preservation for people for those who are having cancer treatment, and those who are undergoing treatment at King’s College Hospital.”

fertility-questions4. How do you decide which treatment someone should undergo?

Your personalised treatment programme should depend on your history, test and investigation results and existing conditions, but will also be influenced by the clinic’s specialism and areas of expertise.

“First of all, it’s to see if there actually is a problem,” explains Dr. Sarris. “For a lot of people, it turns out they do not actually need any treatment, you may just need to give supportive advice or address lifestyle changes or other issues.

“Then if a problem is found, you need to ascertain what that problem is – whether its a historic health issue, or another fertility issue. Once you know what the problem is, then you can decide on the course of treatment. That could be surgery, sometimes its another modification of health issues, and sometimes it’s IVF. Once that decision is made, then it’s straight on to treatment.”

5. Which tests would you advise prior to an IVF cycle?

Any clinic that does not perform thorough initial tests on both you and your partner to investigate potential causes of infertility should be avoided. Determine upfront what the clinic offers and consider whether you are happy with this approach.

“While there are a number of tests, you won’t need to do all of them,” Dr. Sarris explains, adding, “What’s important is to look at the whole story. You need to look at the medical history of the patients seeking treatment.

Sperm Count

“Beyond that, the minimum I would expect would be a sperm sample – to test the sperm count.

Pelvic Ultrasound and Scans

“On the female side, the minimum test one would expect to be able to do is a pelvic ultrasound to look at the womb, the ovaries – where the eggs are being produced – and it’s very important that this test is done from a fertility point of view, not just a gynaecological mindset.

“I very frequently have women turn up and say they’ve had a scan and a doctor had a look at it and it’s all absolutely fine. But that may only be telling you that you don’t have cancer and there’s nothing wrong with you health-wise.  So you’ll need to see a specialist to look specifically for problems with fertility. For example; the number of follicles developing in an ovary, position, and the shape of the womb.

“You may also want to check the fallopian tubes. These are what connect the womb to the ovaries, so the sperm goes through the uterus up the tube, and the egg goes through the tube, meet the sperm, fertilise hopefully and travel down the tube into the womb and then implant. You want to see if that conduit is open.

“Sometimes, a simple scan can show straight away if there are any problems with the fallopian tubes. Under normal circumstances, a normal tube is not visible when scanning and so if you can see it that usually means it’s bad news and it’s blocked and dilated.

“But if you can’t see it, that can mean one of two things. It can either mean, that the tubes are open and working, or it can potentially mean that there is a problem inside, and it’s blocked inside but it hasn’t dilated.”

Tubal Patency Tests

The other way to check is with a tubal patency test. This is done by passing a little bit of fluid, maybe water or dye, through the tubes and at the same time use images to monitor how that fluid is running through the tubes.

“What we do is look at the cervix, like a smear, and pass a tiny tube through and squirt a little bit of fluid up into the fallopian tube,” reveals Dr. Sarris.

“You can scan with an ultrasound at the same time, this is what we do at… and just follow the path of the tube as the fluid comes out. This is called a Hysterosalpingo-contrast-sonography (HyCoSy).

“Or you can use an X Ray – this is called an HSG. You can also do this through surgery, which is called a laparoscopy, this is where you put a camera through the belly button and physically have a look at how the fluid flows through. We usually leave laparoscopies – as they are invasive – to women who also want other procedures or treatments at the same time. For example, if we suspect there’s another problem such as endometriosis.

AMH Blood Test

There are a number of blood test that can be carried out alongside scans, before IVF treatment is sought.

Dr. Sarris says,”Beyond that, we can also carry out a simple blood test called an AMH – Anti-Mullerian Hormone test – to look at ovarian health (again the number of follicles growing). This works hand-in-hand with the scan to give an idea of what is happening with the ovaries.

“You might want to look at the thyroid, blood count, or other hormone issues and balances of the male and female hormones. Interestingly, both males and females have the same hormones, it’s just the balances of each which can affect fertility. These test are not always required for everybody and so one can rationalise what tests are needed and for who.

6. What are the most common causes of infertility in men and women?

Fertility-foods-xmasAccording to Dr. Sarris at King’s Fertility, about half the people treated with IVF at the clinic a problem with the male sperm component exists. It’s not all about the women.

“In terms of the distribution of causes, in around 25% of all the people we treat there’s a problem with female side, 25% the male side, in another quarter there’s a problem with both sides and in the final 25% it’s what we call unexplained.

“This doesn’t mean there isn’t a problem, or no explanation, just that the test carried out thus far have not found the cause.”

Age is the most common cause of decreased fertility – in both men and women.

“Although, there is an absolute point when women stop having periods and eggs being released – the menopause – for men there is no absolute stop, but there is a gradual decline. As they become older there is often a decline in the sperm count.”

Other causes of infertility and decreased fertility:

Azoospermia

“From the male side, a decreased number of sperm – they may have less than average, or they may not be moving as much, or they may be misshapen. The fewer, normal looking or moving sperm someone has, the less likely they are to find an egg.  Surprisingly, around 1% of men have no sperm whatsoever – it’s called azoospermia.

More issues: 

Other issues can include problems with erectile dysfunction or issues with intimacy and sex.

From the female side the most common causes would be blocked tubes, then again potentially other abnormalities within in the pelvis, e.g. abnormal shaped womb, lower uterus, thyroid and also decrease number of eggs. Or, in fact, the opposite – eggs not being released – ovulation problems.

fertility-clinic7. What kinds of treatment might I be offered?

In conventional IVF, fertility medication is given to the woman to suppress her natural cycle and to encourage the ovaries to produce more eggs than usual. A number of eggs are then collected to be fertilised outside of the womb. However, there is a growing acceptance that this method is not always the safest or most effective for many women and other lower or no drug treatments are now starting to be offered by some clinics, including:

Natural Cycle IVF aims to collect the one egg that has been naturally selected by the body. It is carried out without the use of fertility drugs. By utilising natural selection in this way, the hope is to be able to collect a high quality egg and therefore increase the chances of a high quality embryo being created. Studies have linked Natural Cycle IVF to a healthier birthweight for babies born as a result of this method.

Modified Natural Cycle IVF is a form of Natural Cycle IVF. Medication is given for 3-4 days in order to block spontaneous ovulation and a small dose of stimulation hormone is given in order to keep the follicles healthy and growing. Again, the focus is to collect one high quality naturally selected egg, though sometimes more than one egg can be collected.

Sometimes referred to as ‘Mini IVF’, Mild Stimulation IVF is carried out within the natural menstrual cycle and uses minimal doses of fertility drugs in order to achieve a mild response to stimulation. Stimulating medication is given for just 5-9 days, compared to the 4-5 weeks of medication used in conventional IVF.

In Vitro Maturation (IVM): is the collection of immature eggs from a woman, which are then matured in the lab using special and advanced culture conditions to create several embryos.

8. What are the clinic’s success rates and what is the success rate for me in particular?

Bear in mind that not all clinics use the same criteria for measuring success rates. IVF success rates should be treated with caution, but you will want to know that your chosen clinic has a strong track record. It is important to ask how the clinic measures success rates, specifically regarding your circumstances and the treatment you are considering.

9. What is the best age for a woman to have IVF treatment?

The biggest misconception is that IVF can treat age-related fertility decline.

“Unfortunately, there is no such thing as guaranteed success when it comes to IVF and fertility treatment,” reveals Dr. Sarris.

“Having said that, the average in the UK is around 1 in 4 cycles will lead to a birth. But the range of successful IVF can be anywhere from 5% to 50% per cycle.”

There are two major factors which can help determine the success of IVF – however, they are two factors we can’t do anything to change:

  • The age of the egg
  • The number of eggs that the ovary has

“But what we can alter, is to try and increase the chance of success of with what we’ve got,” Dr. Sarris tells Baby.

“For example, if there isn’t enough moving sperm, we can look and under the microscope and then inject that sperm into an egg – which otherwise may not happen naturally. That’s the typical process of IVF

“We can try to get more eggs released by stimulating the ovaries. Somebody that has more eggs will be more successful.

“IVF does not overcome nature, we work alongside nature. We are limited with what is possible.

“There is no ideal age, but the younger someone is, the likely hood of more viable eggs is higher.”

10. What is the cost of one full treatment cycle & are there any hidden costs?

Costs vary from clinic to clinic depending on the procedure and additional costs of medication, blood tests and additional tests. Be clear on the total cost of treatment before you agree to start the process.

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