Additional tests and treatments

The leaflet is detailed below, or you can download the 'Artificial Oocyte Activation (AOA)' leaflet in PDF.

What is AOA?

An oocyte is the scientific term for an egg. When a sperm meets an egg, it triggers something called ‘egg activation’ which begins the process of fertilisation and embryo development. This activation process is caused by sperm factors which lead to an increase of calcium in the oocyte. If the sperm are lacking these factors or the oocytes don’t respond to the factors properly, then the activation process may not occur and fertilisation can fail. Artificial oocyte activation uses a substance called a calcium ionophore which aims to help to activate the egg and improve fertilisation.

How is AOA carried out?

Immediately after your oocytes have been injected using conventional ICSI they are placed in a ready-to-use calcium ionophore solution for 15 minutes. They are then rinsed to remove the calcium ionophore and placed, as normal, into a time-lapse incubator and checked to see if any have fertilised the following morning.

Is AOA for me?

It is possible that for some patients who have had an ICSI cycle with failed (or significantly reduced) fertilisation, the reason for the lack of fertilisation may be due to an inability of the oocytes to activate. Alternatively, some men produce sperm which appear to lack the ability to activate oocytes properly; AOA may help in either of these cases.

There have now been numerous reported cases of live births following the use of AOA for patients who had previous failure (or significantly reduced) fertilisation. These cases have shown that if fertilisation is achieved with AOA, then embryo quality and pregnancy rates are similar to those with standard ICSI. However, we cannot say with certainty that the use of AOA will help your oocytes to fertilise, as there are many other steps involved in this complex process.

Are there any risks with AOA?

It is important to note that AOA has only been certified for diagnostic purposes and not for clinical use. This means that it has not been tested for routine clinical treatment in this country. 

However, there have now been several trials published with no reports of any adverse effects on the health of babies born following the use of AOA. Although, it is important to note that further studies would be required to fully evaluate any risks.

What is the cost of AOA?

There will be an additional charge per treatment cycle. Please see our fee schedule or website for more information.

https://www.thehewittfertilitycentre.org.uk/costs-and-funding/costs/

The Human Fertilisation and Embryology Authority (HFEA) and AOA:

AOA is regarded by the HFEA as a treatment ‘add on’. This means that there is a conflicting body of evidence and further research is required to prove its benefit.

For more information on treatment add-ons please refer to the HFEA traffic-light system on the website:

https://www.hfea.gov.uk/treatments/treatment-add-ons/

The leaflet is detailed below, or you can download the 'Endometrial Scratch' leaflet in PDF.

What is an endometrial scratch?

An endometrial scratch is a procedure that is performed to try to improve the chance of implantation when an embryo is transferred back in to your uterus.

What does an endometrial scratch involve?

Having an endometrial scratch is a lot like having an embryo transfer. During embryo transfer, the embryo is loaded into a very soft catheter and placed into the womb as gently as possible. In contrast, an endometrial scratch involves using a firm catheter that is moved repeatedly inside the uterus to temporarily induce damage to the womb lining.

Most people report the scratch as being more uncomfortable than an embryo transfer, however the discomfort is best described as mild. The procedure itself rarely takes more than 30 seconds to complete.

It is important to use a barrier method of contraception (for example, a condom) from day 1 of the cycle that the scratch is going to be performed.

How does it work?

We are not entirely sure. Some studies suggest that traumatising the lining of the uterus (endometrium) promotes an immune response that increases new blood vessel growth and an influx of certain chemicals and cells that play important roles in implantation. On the contrary, other studies have not reported any difference in live birth rate.

How do I know if I would benefit from an endometrial scratch?

To date, the evidence is contradictory. Your IVF specialist may talk to you about this procedure, however please ask if you feel you require more information.

How do I arrange an endometrial scratch?

In order for you to have an endometrial scratch, you will need to be seen by a clinician. It is normally performed between days 20 and 25 of your menstrual cycle and its effect can last up to 3 months. You will be given a provisional date for the procedure based on your last period date. You will then be contacted the day before your procedure to confirm a specific time. Please arrive 15 minutes before your scheduled appointment and with a full bladder.

Do I need an anaesthetic?

No, the procedure is performed whilst you are awake. It is more uncomfortable than an embryo transfer, but we are able to offer you gas and air which is a mild inhaled anaesthetic. We also suggest taking a simple painkiller such as paracetamol or ibuprofen about an hour before the procedure. Please note we do not allow partners to accompany you whilst you have the procedure.

Are there any risks?

It is generally considered a very safe procedure. The procedure is uncomfortable and you may experience some discomfort and very mild vaginal bleeding after the procedure. There is a very rare chance of developing an infection. If you develop a high temperature within a few days of the procedure, experience severe cramping, or unusual bleeding (not just spotting), or offensive vaginal discharge, or are concerned at any time, please contact the Hewitt Centre for further advice. There is also a small chance that the procedure gets abandoned due to difficult entry.

How much does it cost?

There will be an additional charge as this treatment is not funded by the NHS. Please see our fee schedule or website for more information.

https://www.thehewittfertilitycentre.org.uk/costs-and-funding/costs/

Add-on treatments

Endometrial scratch is generally described to be an ‘add-on’ treatment. For more information on treatment add-ons please refer to the HFEA website:

https://www.hfea.gov.uk/treatments/explore-all-treatments/treatment-add-ons/

 

Document Code: MED-FORM-7	Version No: 11	Document Title: Endometrial Scratch – Patient Information Leaflet
Date of issue: 21.09.2022	Date of review: 21.09.2024	Owner: A Drakeley	Author: R Howard

Endometrial Immunoprofiling

The leaflet is detailed below, or you can download the 'Immunoprofiling' leaflet in PDF.

Infertility affects approximately 10-15% of couples in the UK, requiring them to proceed with assisted reproduction technology (ART). Despite recent advances, one in four attempted IVF cycles results in a baby and only 50% of women under 35 years old achieve a pregnancy after a blastocyst transfer.

Repeated implantation failure (RIF) is determined when transferred embryos fail to implant following several attempts. RIF can occur by chance, or because of underlying problems in the eggs or sperm, or in the embryos or in the lining of the uterus (endometrium) due to what we call reduced endometrial receptivity¹.

A number of tests have been used to understand why embryos do not implant. At present there is little evidence that these tests provide a clinical benefit. A lack of large randomised, controlled trials means that it is difficult to know when it is appropriate to offer patients certain tests.

What tests are available?

Endometrial immunoprofiling is a test that has recently been developed. This test is being offered by an immunology research laboratory in Paris, France. As an extrapolation of the Natural Killer cell test, they believe that different biomarkers measured in an endometrial biopsy taken at the time of presumed implantation will indicate whether a patient’s immune response is normal, low or high.

How is the test performed?

Once the decision has been made with your doctor to undertake this test, we will prepare your womb lining with a combination of oestrogen oral tablets and vaginal progesterone pessaries. A blood test for HIV, hepatitis B &C is required (sampled within the last 12 months). An endometrial biopsy is taken by passing a tube through the cervix and drawing off a sample of endometrial tissue using suction. The sample is placed in a tube and sent to France for analysis. The laboratory does an initial analysis on the sample to check there is sufficient tissue taken at the correct time during the menstrual cycle. At this point, payment by the patient directly to the French laboratory is required. The sample is fully analysed and the result is reported in approximately 3 weeks. A suggested management plan to correct any imbalance is also provided. Should you wish to repeat the test, there is a 20% reduction on the laboratory cost.

Is there any evidence available on this test?

Some studies have suggested that up to 78-81% of women with a lack of implantation will demonstrate an imbalance^2,3. Importantly, they have also derived treatments to normalise the immune response. According to the same studies, when these treatments were used in women with imbalances, both live birth rate and miscarriage rate were improved³. Repeat testing after having any suggested treatments are possible for reassessment. Any randomised controlled trial results for these tests will be evaluated when published.

Immunoprofiling is viewed as an ‘add-on’ treatment as it is not considered routine clinical treatment. For more information on treatment add-ons please refer to the HFEA website:

https://www.hfea.gov.uk/treatments/explore-all-treatments/treatment-add-ons/

Please discuss the current HFEA traffic light status for this treatment with your fertility specialist.

Are there any risks?

The procedure is uncomfortable and you may experience some discomfort and very mild vaginal bleeding after the procedure. There is a very rare chance of developing an infection. If you develop a high temperature within a few days of the procedure, experience severe cramping, or unusual bleeding (not just spotting), or offensive vaginal discharge, or are concerned at any time, please contact the Hewitt Centre for further advice. There is also a small chance that the procedure gets abandoned due to difficult entry.

Steroids are sometimes recommended as a result of the test.  Steroids are immuno-suppressants; they reduce the activity of the immune system, which is the body's natural defence against illness and infection. Steroids do not tend to cause significant side effects if they're taken for a short time or at a low dose. However, steroids can sometimes cause unpleasant side effects. A clinician will explain the risks of taking steroids if this is the recommendation from testing.

How much does the test cost?

As we must consider this test ‘experimental’, we cover our costs and do not profit from offering this test. Please see our fee schedule or website for more information.

https://www.thehewittfertilitycentre.org.uk/costs-and-funding/costs/

*Please note that the courier and laboratory analysis fees are essential for all patients.

If you are unsure as to whether you should have endometrial immunoprofiling, please contact the Hewitt Fertility Centre to discuss further.

 

Document Code: P-INFO-GEN-59	Version No: 6	Document Title: Endometrial immunoprofiling
Date of issue: 21/09/2022	Date of review:  21/09/2025	Owner: S Brooks	Author: R Howard

 

Endometrial receptivity (ERA), Endometrial Microbiome (EMMA) and Analysis of Chronic Endometritis (ALICE)

The leaflet is detailed below, or you can download the 'Endometrial receptivity (ERA), Endometrial Microbiome (EMMA) and Analysis of Chronic Endometritis (ALICE)' leaflet in PDF.

Background

Infertility affects 10-15% of couples in the UK, requiring them to proceed with assisted reproduction technology. Despite the recent advances in these techniques, only 1 in 4 attempted IVF cycles results in a baby and only 50% of women under the age of 35 achieve a clinical pregnancy after having a blastocyst transfer.

Repeated Implantation Failure (RIF)

RIF is determined when transferred embryos do not implant after several attempts. RIF or reduced endometrial receptivity¹ may be caused by:

• Underlying problems in the eggs or sperm
• Underlying problems in the embryos
• Underlying problems in the uterus lining
• Unknown reasons

A number of tests may be used to understand why embryos do not implant. The tests are not guaranteed to give conclusive results. Results from randomised controlled trials assessing the usefulness of these tests are not yet available.

The “endometrial health pack” by Igenomix (Spain) was recently presented at a medical conference as a way of testing RIF. This test consists of an endometrial biopsy that is sent for specific testing.

What tests do we offer?

The ERA test of implantation receptivity challenges the notion that the implantation window is the same for all patients and that for some, replacing an embryo either a day earlier or later may be associated with better results. This would only be appropriate for IVF patients who have a history of RIF. The ERA test is not suitable for patients who experience recurrent miscarriages after natural conception.

The EMMA test looks at the endometrial microbiome and determines the healthy bacteria levels that may play a role in embryo implantation. Probiotic treatment may be suggested to balance the endometrial flora with the aim of improving chance of pregnancy.

The ALICE test looks for 8 types of bacteria that are potentially harmful to an implanting embryo for which antibiotic intervention may be advised.

These tests are considered to be experimental and are offered at a non-profit price to patients.

Costs

There will be an additional charge for this add-on treatment. Please see our fee schedule or website for more information.

https://www.thehewittfertilitycentre.org.uk/costs-and-funding/costs/ 

What is required?

Once the decision has been made with your doctor to undertake this test, an endometrial biopsy is taken between Day 15 and Day 25 of the cycle. It may be necessary to prepare the womb lining with a combination of oral oestrogen tablets and vaginal progesterone pessaries for the biopsy. 

An endometrial biopsy is taken by passing a catheter through the cervix and lightly suctioning the endometrial tissue using gentle catheter pressure. The biopsy sample is deposited in a tube and transported to Igenomix for testing. The test results are usually available after 3-4 weeks. A suggested management plan to correct any imbalance is provided. Igenomix analysis of repeat testing is 20% cheaper for further tests. The cost of the procedure by our clinic also still applies.

The ERA test needs to replicate as closely as possible the planned embryo transfer process, especially in relation to duration of progesterone exposure. We have found through several audits that natural frozen embryo transfers have an increased pregnancy rate and lower miscarriage rate than medicated, however those with irregular cycles and erratic ovulation require a medicated approach. Progesterone is a hormone released gradually after ovulation. Duration of progesterone exposure is important for implantation and the ERA test. For natural FET we ask you to phone with a morning LH surge and the embryo transfer is 6 days later. However, natural ovulation is harder to exactly pinpoint, so if natural FET is planned you need to be aware of this pragmatic interpretation of the ERA result and timing of your embryo transfer. Taking an HCG ‘trigger’ injection does force ovulation, but the hormone profile is a sharp spike, rather than a physiologically gradual rise and fall. Medicated approach (using oestrogen and progesterone) is more controlled but has the disadvantages stated earlier. So, it is important to discuss the planned future techniques for your embryo transfer with the clinic staff. Precise timing for EMMA and ALICE is less important but should ideally be done as described above.

Are there any risks?

The biopsy procedure is uncomfortable and you may experience some discomfort and very mild vaginal bleeding after the procedure. There is a very rare chance of developing an infection. If you develop a high temperature within a few days of the procedure, experience severe cramping, or unusual bleeding (not just spotting), or offensive vaginal discharge, or are concerned at any time, please contact the Hewitt Centre for further advice. There is also a small chance that the procedure gets abandoned due to difficult entry.

These tests are described as ‘add-on’ treatments. For more information on treatment add-ons, please refer to the HFEA website:

https://www.hfea.gov.uk/treatments/treatment-add-ons/

Please discuss the current HFEA traffic light status for this treatment with your fertility specialist.

If you are unsure whether you should have any of these tests performed, please contact the Hewitt Fertility Centre.

 

Document Code: P-INFO-GEN-58	Version No: 5	Document Title: Endometrial receptivity (ERA), Endometrial microbiome (EMMA) and analysis of chronic endometritis (ALICE) Information Leaflet
Date of issue: 30.03.2023	Date of review: 30.03.2026	Owner: S Brooks	Author: R Howard

IMSI

The leaflet is detailed below, or you can download the 'IMSI' leaflet in PDF.

Background

Intra-cytoplasmic sperm injection (ICSI) is a technique, introduced in 1992 to help certain types of infertility. Thousands of couples have become parents as a result of ICSI. It involves the injection of a single sperm directly into the centre of an egg to fertilise it. This procedure bypasses the natural process of the sperm travelling to the egg on its own.

What is IMSI?

Intra-cytoplasmic morphologically selected sperm injection (IMSI) is a more advanced form of ICSI. This technique uses a higher magnification (x6000) to select the sperm used for the injection into the egg. The sperm are carefully chosen by the embryologist, who assesses the sperm head, mid-piece and tail. The sperm are also investigated for structural defects. The best sperm are chosen for the injection based on their appearance.

Are there any risks associated with ICSI or IMSI?

Risks associated with ICSI include the potential for damage to a small number of eggs as they are prepared for the injection procedure.

ICSI has also been associated with certain genetic and developmental defects in a very small number of children born using this treatment. However, it is difficult to determine whether this is a result of the ICSI procedure or the underlying cause of infertility. Follow up studies from children born using this technique are still on-going. Another issue to consider is the possibility that if your child conceived as a result of ICSI is a boy, he may inherit his father’s infertility. At this stage it is too early to know if this is the case.

IMSI is a non-invasive test performed on a semen sample as an additional step to the ICSI process. The risks associated with the use of ICSI also apply to IMSI; there are no significant additional risks to the patient or embryo with IMSI. IMSI just allows the embryologist to take a closer look at the sperm prior to injection. IMSI does not give any information about the genetic content or internal quality of the chosen sperm.

It is important that you discuss possible risks with your doctor before going ahead with treatment. You may also find it helpful to discuss your concerns with a counsellor.

How likely is IMSI to work?

The research that has been carried out generally does not support the use of IMSI over standard ICSI for infertile men. However, the latest Cochrane review stated that the evidence available on IMSI vs ICSI is of very low quality evidence and the benefit of IMSI over ICSI is uncertain due to the limitations of the studies compared¹.

 IMSI may help the following patient groups:

• Men who have a high number of abnormal sperm found in their semen
• Recurrent miscarriage
• Previous failed fertilisation with ICSI
• Poor quality embryo formation in previous treatments

The Human Fertilisation and Embryology Authority (HFEA) and IMSI:

IMSI is regarded by the HFEA as a treatment ‘add on’. For more information on treatment add-ons please refer to the HFEA website:

https://www.hfea.gov.uk/treatments/explore-all-treatments/treatment-add-ons/

Please discuss the current HFEA traffic light status for IMSI with your fertility specialist.

How much does IMSI cost?

There will be an additional charge per treatment cycle. Please see our fee schedule or website for more information.

https://www.thehewittfertilitycentre.org.uk/costs-and-funding/costs/

 

Document Code: P-INFO-GEN-64	Version No: 3	Document Title: IMSI
Date of issue: 21/09/2022	Date of review: 21/09/2025	Owner: R Gregoire	Author: R Howard

Laser Assisted Hatching

The leaflet is detailed below, or you can download the 'Laser Assisted Hatching' leaflet in PDF.

What is laser assisted hatching?

A human embryo has a soft outer ‘shell’ called the zona pellucida (or zona for short). When an embryo is five or six days old and is at the stage known as a blastocyst, it needs to escape or hatch out of the zona. The picture below shows a blastocyst hatching out of the zona.

Once the embryo has hatched out of the zona, it is able to implant into the lining of the womb and a pregnancy hopefully results.

If the embryo does not hatch a pregnancy cannot occur.

What is laser assisted hatching and how is it done?

Laser assisted hatching is a technique whereby a small artificial hole is made in the zona of an embryo using a laser. It is thought that the embryo can then hatch more easily through this hole and hopefully increases the chance of the embryo implanting.

This picture shows the hole made by the laser in the zona of an embryo (indicated by the arrow).

Laser assisted hatching is usually performed just before the embryo transfer procedure.

Laser assisted hatching can be performed on embryos at the early cleavage stages (that is two or three days after the egg collection) and at the blastocyst stage (five or six days after the egg collection).

Is laser assisted hatching suitable for me?

Some patients may produce embryos in which the zona is thickened or hardened making it difficult or impossible for the embryo to implant. Also, patients who have had several embryo transfers without success or patients who are older may wish to consider laser assisted hatching.

What difference will laser assisted hatching make?

It is difficult to say with certainty whether laser assisted hatching improves your chance of pregnancy as the available evidence about this remains controversial. The National Institute for Clinical Excellence (NICE) states “Assisted hatching is not recommended because it has not been shown to improve pregnancy rates.” The Human Fertilisation and Embryology Authority (HFEA) have a traffic light system to rate the clinical effectiveness of add-on treatments. Please discuss the current HFEA traffic light status for laser assisted hatching with your fertility specialist.

Are there any risks with laser assisted hatching?

There is always some risk of damaging embryos with these types of procedures, further research is needed to examine the consequences for children born as a result of this procedure.

What is the cost of laser assisted hatching?

There will be an additional charge per treatment cycle for laser assisted hatching. Please see our fee schedule or website for more information.

https://www.thehewittfertilitycentre.org.uk/costs-and-funding/costs/

 

Document Code: P-INFO-LAH-1	Version No: 10
Document Title: Laser Assisted Hatching Information
Date of issue:21/09/2022	Date of review: 21/09/2025
Owner: R Gregoire	Author: R Howard

Pre-Implantation Genetic Testing for Aneuploidy (PGT-A)

The leaflet is detailed below, or you can download the 'PGTA-A' leaflet in PDF.

What is PGT-A?

Embryos with an abnormal number of chromosomes (aneuploid embryos) are known to have a reduced chance of producing a successful pregnancy and may also result in a baby being born with a genetic condition. Until recently, the only way to determine whether or not an embryo was aneuploid was to wait until a pregnancy was established and then perform chronic villus sampling (CVS) or amniocentesis, to test the chromosomal material in the foetus. If an abnormal number of chromosomes are detected, parents face the difficult choice of whether to continue or terminate the pregnancy. PGT-A (formally known as PGS) is a new technology which helps to identify embryos that have an abnormal number of chromosomes at this very early stage, and as such, are not transferred. 

How is PGT-A carried out?

The technique of PGT-A involves carrying out a biopsy on suitable embryos (those that have developed to the correct stage) and testing for any abnormalities in the number of chromosomes, in the hope to identify and transfer an embryo with the correct number of chromosomes. The biopsy is performed on suitable blastocysts (at either the day 5 or day 6 stage). The embryos are frozen whilst we obtain the genetic result and then transferred in a future cycle.

What is the evidence to support PGT-A?

There is some evidence to show that IVF success rates can be improved if embryos are tested for aneuploidy, with only those found to have the correct number of chromosomes transferred to the womb^1,2. It has also been reported that PGT-A significantly reduces the chance of having a pregnancy affected by certain genetic conditions¹. A recent multi-centred randomised clinical trial reported no significant improvement in pregnancy outcomes in all women after PGT-A treatment³.PGT-A is not yet considered to be a standard technique and consequently we strongly recommend that patients who become pregnant through PGT-A undergo prenatal testing using CVS or amniocentesis, to confirm whether or not the foetus has a correct number of chromosomes.

Is PGT-A for me?

We may recommend PGT if:

• You are over 35 and have a higher risk of having a baby with a chromosome problem (such as Down’s syndrome)
• You have a family history of chromosome problems
• You have a history of recurrent miscarriages
• You have had several unsuccessful treatments where embryos have been transferred
• Your sperm are known to be at high risk of having chromosome problems

Please Note: You are not obliged to undergo PGT-A, even if your doctor recommends it.

Are there any risks with PGT-A? 

In some cases, it may be that embryos are too poor quality to undergo the biopsy and testing process. If embryos are suitable for biopsy, there is a risk of damage to the embryo through the biopsy procedure, however this risk is quoted to be less than 1%. Additionally, although current PGT-A techniques are mostly very accurate, the test may give the wrong result (i.e. it may miss an abnormality, or detect one that isn’t there).

If both the procedure and testing are carried out successfully, research has shown that babies born after PGT-A show no increase in congenital abnormalities above the general rate for IVF children⁴.

What is the cost of PGT-A?

There will be an additional charge per treatment cycle for PGT-A so please discuss this with your doctor.

The Human Fertilisation and Embryology Authority (HFEA) and PGT-A:

PGT-A is regarded by the HFEA as a treatment ‘add on’. For more information on treatment add-ons please refer to the HFEA traffic-light system on their website:

https://www.hfea.gov.uk/treatments/treatment-add-ons/

Please discuss the current HFEA traffic-light status for the use of PGT-A with your fertility specialist.

 

Document Code: P-INFO-PGS1	Version No: 2	Document Title: PGT-A Patient Information
Date of issue: 21.02.2023	Date of review: 21.02.2026	Owner: R Lunt	Author: R Howard

CryoRobot Select (CRS) 

The leaflet is detailed below, or you can download the 'CryoRobot Select (CRS)' leaflet in PDF.

What is the CryoRobot Select (CRS)?

The cryostorage systems currently used in IVF clinics worldwide mostly rely on technology that was developed more than four decades ago. These manual storage systems involve human processes for handling specimens and for documenting patient information. Although the current manual system is effective, it involves unnecessary handling and movement of patient samples during removal of samples for unrelated procedures.

Over the last three years, the Hewitt Fertility Centre has completed in-depth studies to quantify the potential hazards associated with manual cryostorage of eggs and embryos following fertility treatment. The findings of these studies have shown that there continues to be risks associated with manual cryostorage for in vitro fertilisation (IVF), even when clinics use radio frequency identification (RFID) witnessing technology and with well-established standard operating procedures to reduce risk.  

The CryoRobot Select (CRS), developed by TMRW Life Sciences, is a groundbreaking advancement in IVF cryostorage. TMRW developed the first automated platform designed for the safe management and storage of frozen eggs and embryos. This innovative technology has recently become accessible for cryostorage following fertility treatment, and the Hewitt Fertility Centre is the first clinic outside of the USA to make it available to patients. The CRS uses digital technology to effectively monitor, track, and retrieve frozen eggs and embryos, and so significantly reduces the number of potential points of failure caused by unnecessary handling of patient samples when using routine manual cryostorage systems.

• Individually contained beacons
• Reduced manual handling events
• Ideal for long-term storage
• Scan the QR code below for more information:

Who can use the CRS?

The CRS is available for patients with eggs or embryos available for storage after their fertility treatment or for those who already have eggs or embryos in manual storage.

How can you request the CRS for your egg or embryo storage?

If you would like more information on the CRS as part of your treatment and any cost implications, this will be provided during an appointment with your clinician when planning your NHS or self-funded treatment. 

 

Document Code: QMS-DOCTEMP-4	Version No:1	Document Title: Patient information leaflet template
Date of issue:29.03.2021	Date of review: 29.03.2023	Owner: S Brooks	Author: R Howard

The leaflet is detailed below, or you can download the 'PICSI' leaflet in PDF.

What is PICSI?

Physiological-ICSI (PICSI) is a modified form of ICSI, which includes an additional method of sperm selection. During standard intra-cytoplasmic sperm injection (ICSI), the ICSI practitioner selects the best sperm available for injection, based on how the sperm looks (morphology) and moves (motility). Just by looking at the outside of the sperm, the practitioner does not know if the sperm is good quality or ‘mature’ and therefore less likely to contain DNA damage. We know that ‘immature’ sperm containing DNA damage can look normal and move well.

The egg is surrounded by a group of cells which contain a compound called Hyaluronan. In natural conception and standard IVF, the sperm binds to hyaluronan, which allows it to push through these cells to reach and fertilise the egg. Sperm that can bind to hyaluronan are known to be more ‘mature’, contain less DNA damage and are considered better quality.

The PICSI procedure is very similar to ICSI but instead of the practitioner selecting the sperm based on how it looks and moves alone, the sperm are also selected based on their ability to bind to hyaluronan in the laboratory. This is done by putting the sperm in a dish which has hyaluronan on its surface. Sperm that stick to the hyaluronan (the surface of the dish) are selected and then assessed for how they look and move, before injecting into the egg

 

Will PICSI improve my chance of a healthy live birth?

Several studies have shown PICSI may reduce the risk of miscarriage in certain groups of patients compared to ICSI. The largest randomised controlled trial to date, the HABselect trial, showed that PICSI significantly reduces the risk of miscarriage. This finding was a secondary outcome, which means the study was not designed to look at the effects of PICSI on miscarriage, making this result less reliable. However, when researchers looked more closely at the miscarriage data from this trial, they were able to show that in couples were the egg provider is 35 or over, PICSI significantly reduces the risk of miscarriage compared to ICSI. Although the trial did not show a significant difference in overall live birth rates, by reducing the risk of miscarriage in older patients, it gave them a comparable chance of a live birth to a younger patient when using PICSI.

Can PICSI improve the quality of my embryos?

There are a small number of studies showing that PICSI improves embryo quality, however the quality of these studies is poor. There is no reliable data showing PICSI improves embryo quality.

  Are there any risks associated with PICSI?

The risks of PICSI are the same as ICSI which include:

• Damage to a small number of eggs during preparation for injection
• Damage to a small number of eggs during injection
• No eggs suitable for injection after being prepared for the procedure
• ICSI has previously been linked with certain genetic and developmental defects in a very small number of children born using this treatment. However, it is difficult to determine whether this is a result of the ICSI procedure of the underlying cause of infertility. Follow up studies from children born using ICSI and PICSI are still on-going.
• There is a possibility that if your child conceived from PICSI is a boy, they may inherit their father’s infertility. At this stage, it is too early to know if this is the case.

PICSI does not have any additional known risks for the person having treatment or for children born from PICSI. However, there is a chance that during the PICSI procedure, no sperm bind to the hyaluronan coated surface. In this case, the embryologist will need to perform standard ICSI.

If you need more information about the genetic risks of PICSI, please contact us.

It is important that you discuss possible risks with your doctor before going ahead with treatment. You may also find it helpful to discuss your concerns with a counsellor.

How could PICSI help me?

PICSI could help reduce your risk of miscarriage if you are already having ICSI (please see ICSI information leaflet) and the egg provider is 35 or older. 

There is limited evidence that PICSI could help you if you have a history of recurrent miscarriage and in cases where the sperm provider has a high level of DNA damage as shown by a DNA damage test.

 

Please note that whereas ICSI can be performed if the sperm are moving but not swimming, PICSI does require some sperm to be swimming. In some cases, where the egg provider is 35 or older, we may not be able to perform PICSI if there aren’t enough swimming sperm.

If after reading this, you are unsure if PICSI would benefit you, please contact us and ask to speak to our embryology team or email our embryology team using the email addresses at the end of this leaflet.

What is the cost of PICSI?

There is an additional charge per treatment cycle for PICSI. Please see our fee schedule or website for more information. https://www.thehewittfertilitycentre.org.uk/costs-and-funding/costs/

The Human Fertilisation and Embryology Authority (HFEA) and PICSI:

PICSI is regarded by the HFEA as a treatment ‘add on’ and its current status is ‘red’ according to the HFEA ‘traffic light’ system. This means that there is a conflicting body of evidence and further research is required to prove its benefit. However, this does not take into consideration the latest published evidence.

For more information on treatment add-ons please refer to the HFEA traffic-light system on the website:

https://www.hfea.gov.uk/treatments/treatment-add-ons/

What should I do next?

If you have any questions after reading this leaflet or if you wish to have PICSI in your next treatment cycle, please email the embryology team at your designated treatment centre as below:

For treatment at Knutsford: lwft.embryohfcknutsford@nhs.net

For treatment at Liverpool: lwft.emrbyologyenquiries@nhs.net

 

Document Code: P-INFO-GEN-78	Version No: 1	Document Title: PICSI information leaflet
Date of issue: 23.01.2024	Date of review: 23.01.2026	Owner: R Gregoire	Author: L Duncalf

 

 

To be added