IVF/ICSI Treatment

The leaflet is detailed below, or you can download the 'What does IVF Involve' leaflet in PDF.

What does In-Vitro Fertilisation (IVF) involve?

IVF involves collecting eggs from the ovaries, putting them together with sperm in a dish, and if they fertilise, putting one or two of the embryo(s) that result back in the womb.

What does IVF Involve?

Naturally each month the ovaries develop several eggs, and usually only one is ovulated and released into the fallopian tube. During IVF, drugs are given to stimulate the production of more eggs to increase the chance of making embryos for embryo transfer or freezing. There are several ways to stimulate egg production and the most suitable method will be decided for you when we have discussed your medical history and test results. We want your treatment to be as convenient for you as possible; you have the choice between our Liverpool and Knutsford (near Manchester) centres for egg collection.

 Once you have started treatment, we will need to find out how well your body is responding by using vaginal ultrasound scans. We use a special ultrasound machine and ask you to empty your bladder before your scan. The ultrasound probe is inserted carefully into the vagina to measure the size of any ovarian follicles. Most people find this examination less uncomfortable than having a smear taken or an internal examination. On the day after the last daily hormone injection, you will need an injection of the hormone human Chorionic Gonadotrophin (hCG). This matures the eggs which should be ready for collection 36 hours later.

Egg Recovery

36 hours after the hCG injection, we will collect the eggs from your ovaries. This is carried out using some of the same equipment used for the scans. We pass a fine needle through the back of the vagina and into each ovary. The fluid from each follicle is collected into tubes to be examined by an embryologist who looks for eggs using a microscope. The whole procedure takes about 10- 15 minutes. You will usually have your eggs collected under sedation. Your clinician will discuss sedation with you before you start your treatment. You can expect to be in the clinic for 3-4 hours on the day of your egg collection.

What happens in the embryology laboratory?

 The next stage is to put the sperm together with the eggs. If you are using partner sperm, the sample should be produced in the morning of the egg collection. If you are using frozen sperm (donor or partner), the sperm will be thawed after successful egg collection. The sperm are prepared and mixed with the eggs by either conventional IVF or intra-cytoplasmic sperm injection (ICSI). The day after egg collection we can examine the eggs for fertilisation. Not all eggs fertilise properly, therefore not every egg will form a viable embryo. Eggs which have displayed normal signs of fertilisation are called embryos. Embryos are cultured for several days until either embryo transfer and/or freezing.

What is the difference between IVF and ICSI?

IVF is used if the semen sample meets specific IVF quality criteria based on motility, count and morphology. Conventional IVF is the process of mixing the eggs with the prepared sperm in a dish and incubating them overnight. ICSI is used for patients with poorer semen quality or in cases of low or failed fertilisation from previous cycles. ICSI involves selecting a single sperm and injecting it into each mature egg by a highly trained embryologist. ICSI allows the use of sperm that may not otherwise have been able to fertilise an egg. There is a risk of low or failed fertilisation with either method of insemination. We will give you a recommendation of which treatment is more suitable for your needs based on your previous history and semen quality.

Are there any risks associated with ICSI?

Eggs are prepared for ICSI by removing the cells from around the eggs, and this process may cause damage to a small number of eggs. The number of eggs available for ICSI can also decrease if they are not mature after the cell removal process. There is also a small risk that the injection process used to insert a sperm into each egg can cause egg damage.

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 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 you conceive a male child as a result of ICSI, there is a risk of inherited male infertility. At this stage it is too early to know if this is the case. If you need more information about the genetic risks of ICSI, 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 ICSI help me?

ICSI could be helpful if you or your partner have:

• Low sperm count (oligozoospermia)
• Abnormal sperm shape (poor morphology)
• Sperm with poor swimming ability (poor asthenozoospermia)
• Sperm that cannot bind or penetrate the eggs for an unknown reason
• Damaged or missing tubes (vas deferens) which carry sperm from the testicles to the penis
• Immune system adverse reaction to sperm (anti-sperm antibodies)
• Difficulty obtaining an erection or achieving ejaculation. This particularly affects men with spinal cord injuries, Hodgkin’s disease and numerous other disorders.
• Previous failed or low fertilization
• Failed reversed vasectomy. Testicular sperm extraction (TESE) may be required to obtain sperm. For more information about TESE and what it involves, and whether these may be options for you, please speak to your doctor.

What are my chances of having a baby with ICSI?

The chances of having a baby using ICSI are similar to those for IVF. As with most fertility treatment, success depends on many factors such as female age and sperm quality. For up-to-date information and access to recent patient experiences using ICSI, please use the following link to access the HFEA website:

https://www.hfea.gov.uk/treatments/explore-all treatments/intracytoplasmic-sperm-injection-icsi/

Embryo Transfer

Embryo transfer is organised for either day three or day five of embryo development, with day of egg collection counted as day zero. An embryo is only selected for embryo transfer if it has met the development stage expected for the day of embryo culture. The embryo transfer procedure is quick and simple. A fine plastic tube containing the embryo(s) is passed through the neck of the womb and the embryo(s) are placed high into the womb. The policy in our unit is to replace one embryo at a time to reduce the risks associated with multiple pregnancies. Double embryo transfer is only considered after several failed attempts, poor quality embryos or advanced maternal age. We will talk about the number of embryos to be transferred before your treatment. Any other embryos not replaced at this time may be frozen, provided they are of a suitable quality to freeze. Following your embryo transfer you will be given further advice about your aftercare from the staff before you go home. The fertility drugs that you have been given sometimes cause the ovaries to be less effective than usual in preventing the start of your next period. We help prevent this by giving you a hormone called progesterone which is given in the form of a pessary. We will discuss how to take this and how often during your treatment.

Pregnancy Testing

Two weeks after your embryo transfer you will carry out a pregnancy test. After the result of the pregnancy test, we will spend time talking things over with you. If you are pregnant, we will be able to offer pregnancy advice and support and arrange a scan. If the treatment has not worked, then there are always things we learn from your cycle. We can use this information to plan another course of treatment should you want this. The way your body has responded to the drugs will often give us clues about the problems that might have stopped you from becoming pregnant naturally. Sometimes we can also find out more about the ability of your eggs to fertilise.

What are the risks of fertility treatment?

There are several risks associated with IVF, these include how your body responds to the drugs during treatment. It is important that you read the leaflet 'Ovulation Stimulation' for further information on possible side effects of the medications used during treatment.

There are also risks associated with the embryology laboratory. The embryology laboratory cannot guarantee egg fertilisation or normal embryo development during your treatment. Our highly trained staff will handle your eggs, sperm and embryos with great care, but this does not eliminate the small risk of loss or damage during handling tasks. We have strict protocols to ensure we can do our very best during each laboratory procedure. There are however more risks associated with certain procedures than others. Please see our ‘Egg freezing’ and ‘Embryo Freezing and Thawing’ leaflets for more detailed information on risks. We will do our very best within the laboratory to ensure we have done everything we can to encourage the best possible outcome of your treatment.

 Complications of fertility treatment

Complications are very rare, for example infection rates after egg collection are very low. In our experience, a bacteraemia is encountered once every 3 years giving an approximate incidence of 1:3000. Bleeding and pain may occur after egg collection but the risk of this is low. As we offer treatments at two different locations, it is important to know how your care will be managed if we were to encounter any complications. Our Liverpool site is based at The Liverpool Women’s Hospital which has excellent access to emergency care services on site. The centre based in Knutsford is based in a rural area which means in the event of an emergency, care would be transferred to the reputable emergency care facilities of Wythenshawe Hospital.

Multiple pregnancies are more common when more than one embryo is replaced at any one time. A multiple pregnancy can be very difficult with a higher risk of miscarriage and complications (bleeding, raised blood pressure and premature labour) than a pregnancy with a single baby. Twins (or triplets) are more likely to be born with a disability as abnormalities and infant mortality are much greater in multiple birth babies than single babies.

If a pregnancy occurs, unfortunately there is still a risk of a miscarriage or an ectopic pregnancy (this is when the pregnancy develops outside of the womb). If at any time you have any questions or queries, please do not hesitate to contact the unit. If at any stage, you wish to see one of our counsellors this can be arranged for you.

This leaflet can be made available in different formats on request. If you would like to make any suggestions or comments about the content of this leaflet, then please contact the Patient Experience Team on 0151 702 4353 or by email at pals@lwh.nhs.uk

Document Code: P-INFO-GEN-74	Version No: 2	Document Title: What does IVF involve?
Date of issue: 09/05/24	Date of review:09/05/27	Owner: S Brooks	Author: R Byrne

Ovarian Stimulation

The leaflet is detailed below, or you can download the 'Ovarian Stimulation' leaflet in PDF

What is ovarian stimulation?

Ovarian stimulation is the process of stimulating your ovaries using fertility drugs (either tablets or injections). In natural ovarian stimulation during the first part of the menstrual cycle, many eggs are stimulated but only one or two may be selected for ovulation. The aim of medicated ovarian stimulation is to increase the number of eggs that would normally be available for the egg collection procedure. There are several ways to stimulate egg production and the most suitable method will be decided for you when we have discussed your medical history and test results.

At the beginning of the month when you start your medication, barrier contraception should be used, as a natural pregnancy at this time could be affected by the drugs you are taking. The first drug you need to take downregulates part of the brain called the pituitary gland, the effects of this make the body mimic a temporary menopause. Downregulation is used to ensure the body responds in a more controlled way to fertility hormones. Following this, drugs containing fertility hormones are given to act on the ovaries to make them produce more eggs. The fertility drugs need to be given every day for about 10-12 days. Injections are taken under the skin, you can either do your injections after you attend a teaching session or you can ask your local GP practice nurse to do them for you.

What are the benefits of ovarian stimulation?

For women who do not ovulate each month, using stimulation may improve this and help your ovaries to produce one or more eggs after the stimulation.

What are the risks of ovarian stimulation?

The ovarian stimulation tablets (Clomiphene, Clomid or Tamoxifen) have very few side effects. Side effects most reported are occasional abdominal discomfort, breast tenderness or mild nausea. Less common side effects are skin rashes, dizziness, and very rarely, visual blurring or headaches. The injectable ovarian stimulants can cause bloating, twinges of discomfort from your ovaries and increased mucus production around the neck of the womb.

The downregulation drugs (e.g. Buserelin) used to stop your ovaries working temporarily at the beginning of your cycle and can cause side effects that are similar to the menopause. These side effects include hot flushes, night sweats, vaginal dryness, headaches and mood swings. Usually, side effects reduce when you start the fertility injections and your ovaries begin to work again.

Ovarian Hyperstimulation Syndrome (OHSS)

The use of ovarian stimulation drugs can cause a condition known as Ovarian Hyperstimulation Syndrome (OHSS) in approximately 1% of cases. OHSS develops when the ovaries overrespond to the fertility drugs and produce too many eggs leading to enlargement of the ovaries. This is usually accompanied by a feeling of being unwell, often with abdominal swelling, nausea, and vomiting. This is a potentially life-threatening disorder, but the chances of it occurring are extremely low. We will try to ensure that if you start developing OHSS, we will treat and monitor you at the earliest possible moment.

Multiple Births

Twin pregnancies are more common with the use of fertility drugs. The incidence increases from 1% in normal conception to 5% with Clomiphene (Clomid). Triplet or quadruplet pregnancies do happen, but rarely.

What are the alternatives to ovarian stimulation?

If the treatment you are hoping to have requires your ovaries to be stimulated, there is not really any alternative to stimulation. If you are concerned about the medication which has been prescribed for you, please do not hesitate to talk to a member of staff.

 

Document Code: P-INFO-GEN-75	Version No: 1	Document Title: Ovarian Stimulation
Date of issue: 13.12.2023	Date of review: 13.12.2026	Owner: R Russell	Author: R Byrne

 

 

ICSI

The leaflet is detailed below, or you can download the 'ICSI' 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.

What is the difference between IVF and ICSI?

Both IVF and ICSI start with the same processes; egg collection and sperm preparation. The difference between the procedures is the process of insemination. Instead of the sperm being mixed with the eggs as in IVF, with ICSI, a single sperm is injected directly into each egg. A highly trained embryologist selects a singular sperm based on their shape and movement for each egg injection. ICSI allows the use of sperm that may not otherwise have been able to fertilise an egg.

Are there any risks associated with ICSI?

Eggs are prepared for ICSI by removing the cells from around the eggs, and this process may cause damage to a small number of eggs. The number of eggs available for ICSI can also decrease if they are not mature after the cell removal process. There is also a small risk that the injection process used to insert a sperm into each egg can cause egg damage.

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 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 you conceive a male child as a result of ICSI, there is a risk of inherited male infertility. At this stage it is too early to know if this is the case. If you need more information about the genetic risks of ICSI, 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 ICSI help me?

ICSI could be helpful if you or your partner have: 

• Low sperm count (oligozoospermia)
• Abnormal sperm shape (poor morphology)
• Sperm with poor swimming ability (poor asthenozoospermia)
• Sperm that cannot bind or penetrate the eggs for an unknown reason
• Damaged or missing tubes (vas deferens) which carry sperm from the testicles to the penis
• Immune system adverse reaction to sperm (anti-sperm antibodies)
• Difficulty obtaining an erection or achieving ejaculation. This particularly affects men with spinal cord injuries, Hodgkin’s disease and numerous other disorders.
• Previous failed or low fertilisation
• Failed reversed vasectomy. Testicular sperm extraction (TESE) may be required to obtain sperm. For more information about TESE and what it involves, and whether these may be options for you, please speak to your doctor.

What are my chances of having a baby with ICSI?

The chances of having a baby using ICSI are similar to those for IVF. As with most fertility treatment, success depends on many factors such as female age and sperm quality.

For up-to-date information and access to recent patient experiences using ICSI, please use the following link to access the HFEA website:

https://www.hfea.gov.uk/treatments/explore-all-treatments/intracytoplasmic-sperm-injection-icsi/

 

Document Code: P-INFO-GEN-42	Version No: 6	Document Title: ICSI leaflet
Date of issue: 05.10.2023	Date of review: 05.10.2025	Owner: R Gregoire	Author: R Byrne

Embryoscope^TM

The leaflet is detailed below, or you can download the 'Embryoscope^TM' leaflet in PDF.

Patient Information

During treatment by in-vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI), your embryos are kept in strictly controlled and heated incubators. Over a period of 2 – 6 days your embryos are regularly examined to see which are developing normally and are most likely to result in a pregnancy.

Historically, monitoring your embryo’s development involved removing the plastic dishes in which they are growing from the incubator to examine them under a heated microscope. They were then returned to the incubators as quickly as possible to keep the temperature and surrounding conditions constant and to avoid any damage to your embryos. In order to reduce these disturbances, they were only checked once or twice a day, offering brief ‘snapshots’ of your embryos. During these checks the embryologist would assess your embryos to determine which have the highest chance of implantation.

By contrast, the Embryoscope^TM offers continuous “live” surveillance of your embryos in a safe, undisturbed and controlled environment from which they do not have to be removed for examination. A large screen provides a continuous view of all the embryos within the incubator.

In addition, continuous time-lapse ‘moving’ images are stored automatically within your patient file for review at any time during the embryo’s development. Embryo development videos are stored on our database, if you wish, we can provide you with a video containing the images of your embryos after your transfer.

 

 

 

 

 

 

 

In addition, the EmbryoScope^TM logs the embryos’ development constantly so that their progress can be reviewed. We can see things that we might have missed before because it didn’t happen at a time when we were examining them under the microscope. Additionally, in the fallopian tubes and womb, nature provides a very stable environment for embryos, and we try to mimic this in the IVF lab – this new incubator is the best thing we have had so far to do that. It is possible to observe key development events in the EmbryoScope^TM, this helps us select which embryos are most likely to result in pregnancy and there is a growing body of evidence to suggest that its use increases the chance of treatment working.

“Embryos are dynamic, constantly changing as they grow and develop. Historically we used to only get a ‘snapshot’ view of the embryos. With the Embryoscope^TM we can now see exactly how an embryo has developed for the entire time it has been in our care, without having to remove it from its optimal environment” Dr Gregoire, Scientific Director of The Hewitt Fertility Centres

PLEASE NOTE: EmbryoScope^TM Time lapse technology is used in all cycles at The Hewitt Fertility Centre as standard practice and will not be charged as an ‘add-on’ to your treatment.

Embryo development data is stored for twenty years post treatment. Please note that information is only stored for embryos with a normal fertilisation status.

 

Document Code: P-INFO-GEN-10	Version No: 7	Document Title: EmbryoscopeTM Patient Information
Date of issue: 02.05.2023	Date of review: 02.05.2026	Owner: R Gregoire	Author: R Howard

The leaflet is detailed below, or you can download the 'Embryo Freezing and Thawing Patient Information' leaflet in PDF.

When are embryos frozen?

Embryos are grown to the blastocyst stage (when possible) to assess the quality of the embryos over several days. Blastocyst transfer takes place on day 5. Any ‘spare’ embryos are checked for freezing suitability after your embryo transfer has taken place. Good quality embryos are frozen and stored for later use. Any remaining embryos on day 6 are assessed and then frozen if they are suitable. If you are having a freeze all (you are not having a fresh embryo transfer), we will assess your embryos throughout days 5 and 6 and freeze any suitable embryos.

Can you freeze all my spare embryos?

We know that only very good quality embryos are able to withstand the freezing and thawing process. We do not freeze embryos that do not have a good chance of surviving the freezing and thawing processes. Embryo quality is a clinical judgement made by a Clinical Embryologist. Embryo quality will be discussed with you before your embryo transfer. If you are having a freeze all, embryo quality will be discussed with you on the final day of freezing (day 6 after egg collection).

How will you freeze my embryos?

We use a technique called vitrification to freeze your embryos. This process uses protective chemicals to freeze the embryos safely. Individual embryos are frozen inside labelled plastic straws that are sealed and stored in liquid nitrogen (-196°C).

How do you thaw my embryos?

We simply take your embryo(s) out of liquid nitrogen and warm the embryo(s) up quickly to body temperature. We remove the protective chemicals from the embryos that enabled them to be frozen safely.

Do all embryos survive the freezing and thawing process?

We expect the majority of embryos to survive, however some do not survive. The survival rates for good quality blastocysts are approximately 90-95%. Blastocyst survival rates are known to be poorer when the blastocyst grade is borderline or poor quality. It is important to understand that as well as survival, blastocysts need to show ‘signs of life’ to be suitable for embryo transfer. ‘Signs of life’ are recorded by a Clinical Embryologist when the embryo starts to re-expand. Blastocysts can often contract into a tight ball of cells during the freezing/warming process and need time to re-expand. Re-expansion can take between 1-2 hours to observe, this may delay your embryo thaw results on the day of your embryo transfer. If your embryo does not survive the thawing process and you have another embryo in storage, we will ask your permission to take the second embryo out of storage for thawing.

How do you choose the best frozen embryo(s) to transfer?

The quality of your embryo(s) is recorded before freezing. Embryos are frozen separately on labelled straws to ensure their identity and grade is identifiable. The embryos will be thawed in order of ‘best’ quality first to give you the best chance of achieving a clinical pregnancy.

Can you re-freeze embryos?

Yes, we can re-freeze embryos if needed. As far as we can tell, if the embryo has survived the freezing and thawing process, it can be re-frozen. The chances of the embryo not surviving the second thawing process may be slightly increased.

What are the legal implications for storing embryos?

All fertility centres are under the regulation of the Human Fertilisation and Embryology Authority (HFEA). Prior to freezing and storing embryos, it is a legal requirement that you give written consent concerning;

• Storage of your embryos and the length to which they are stored for.
• The circumstances to which your embryos can be used in the future.
• What happens to your frozen embryos in the event of your death or incapacitation

You are free to withdraw or vary the terms of your consent at any time. You should be aware that in the event of your death, you can have your name registered as the parent of any child or children born because of using your embryos, provided you have consented to this in writing. If your circumstances change, for instance you move address, change telephone number, or separate from your partner at the time of storage, it is vitally important that you make the Hewitt Fertility Centre aware of these changes immediately.

How long can my embryos remain in storage?

The law now permits you to store embryos for use in treatment for any period up to a maximum of 55 years from the date that the embryos are first placed in storage. However, crucially for storage to lawfully continue you will both need to renew your consent every 10 years. Please note that extension of storage incurs a cost for private patients and may also incur a cost for NHS patients (this is CCG dependent). Please be aware that it is unlawful to store embryos and gametes beyond the storage consent period. Our clinic has a legal obligation to dispose of gametes and embryos once storage consent has expired. 

Are there are risks in freezing or re-freezing embryos?

There is no evidence that freezing embryos is harmful to the baby in any way (but remember that some of your embryos may not survive the freezing and thawing process). Frozen embryos are stored in liquid nitrogen and this presents a theoretical risk of potential cross-contamination between samples in storage. To reduce this theoretical risk, all patients are screened for viral diseases (Hepatitis B, Hepatitis C and HIV) and stored appropriately according to viral status.

This leaflet can be made available in different formats on request. If you would like to make any suggestions or comments about the content of this leaflet, then please contact the Patient Experience Team on 0151 702 4353 or by email at pals@lwh.nhs.uk

 

Document Code: P-INFO-GEN-65	Version No: 4	Document Title: Embryo Freezing and Thawing Patient Information
Date of issue: 09.10.2023	Date of review: 09.10.2025	Owner: H Newby	Author: K. Wagg

 

Screening Clinic

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

It is natural to feel apprehensive before attending your appointment we hope this leaflet will explain what to expect.

What to expect at your appointment?

This appointment is for you and your partner (if you have one), it is very important that your partner (if you have one) attends this appointment so you are both aware of the tests that are required and so a medical history can be obtained from you both.

The appointment can last up to 90 minutes. 

We are a teaching hospital and on occasion we may have trainee medical and clinical staff working within our qualified team. We will always check this is okay with you prior to starting your consultation

Be prepared to answer questions

In order to provide an in-depth medical history, it’s important to be open and honest even though you may feel a little embarrassed.

• Please bring a list of medication that you are both taking (if applicable)
• We will need to ask you how long you have been trying to get pregnant, how often you have sexual intercourse and if there are any difficulties.
• We need to ask If you have had any previous pregnancies (including miscarriages and termination of pregnancy)
• We will ask about your past medical history
• We will ask about your lifestyle including smoking, recreational drugs and alcohol intake.

Please ensure you have added your partner details (if you have one) via the QR that was sent on your appointment letter. We require this information 7 days prior to you attending. If we don’t receive this information in advance, it will cause delays to your appointment time whilst you complete the forms in the waiting area.

Common Fertility Tests/ Screening

During your appointment you will see one of our Sonographers/ Nurse Sonographers and a Transvaginal Ultrasound Scan may  be performed.

This is where an internal scan probe is inserted into the vagina. Some people may find this procedure a little uncomfortable, but this gives a very clear view of the womb and ovaries. An Antral-Follicle Count will be performed, Antral follicles are ovarian follicles that still contain immature eggs. If the ultrasound reveals very few antral follicles, it is an indicator of fewer eggs remaining. The antral follicles reduce with an increase in a woman’s age.

The sonographer will write a report about the findings which will be discussed with you at your next appointment.

If you feel you are unable to tolerate a transvaginal scan, or have a medical reason that means this would be difficult, please attend the clinic with a full bladder and inform a nurse on arrival. 

During your appointment you will also see another member of the team who will organise/ obtain further tests, including blood tests.  They will also check your BMI (this is a value derived from ratio of height and weight).

Tests for Woman

Rubella immunity screening - this is a blood test to ensure you have immunity to Rubella (G

erman Measles), Rubella can be very serious if a pregnant woman catches it in the early stages of pregnancy.

Anti-Mullerian Hormone (AMH) - is produced by small follicles (pouches which contain the eggs) growing in the ovary. It can be measured in a blood test. The level of AMH reflects how many follicles are growing, which gives an indication of how many eggs are present in the ovary. The number of eggs present in the ovary declines as we age, until the menopause, when the supply runs out. The more follicles that are growing, the higher the level of AMH in the blood. This test is interpreted alongside the Antral Follicle Count scan.

Progesterone - this is a blood test to check if you are ovulating.

Chlamydia Screening- Chlamydia is a sexually transmitted infection that can affect fertility; a urine sample is obtained to detect this.

Tests for Men

Semen Analysis- It is important that a semen analysis (within the last year) has been performed. This is to check if there are any problems with your sperm. An appointment will be organised so that the sample can either be produced at home and brought to the andrology section of the unit or produced on site.

A further information leaflet will be given about this.

Blood tests- Occasionally hormone blood tests may need to be performed.

What your appointment is not

• This appointment is not to check about your eligibility for NHS fertility treatment. That will be checked by a separate office within the hospital based on your CCG and individual circumstances.
• The appointment is not to give results of any previous investigations, it is a screening clinic to instigate investigations.

Next Steps

After your appointment a follow- up appointment will be made with a clinician to discuss your results of the tests performed and next steps. This is usually via a telephone consultation.

Occasionally (depending on your individual history) a test to check the patency of fallopian tubes is made for the woman.

Hysterosalpingo-contrast-sonography test (a Hycosy test) is arranged. This is a procedure using advanced ultrasound to test for common symptoms such as blocked fallopian tubes. A contrast agent is passed into the uterus via a fine catheter and the sonographer tracks this agent using ultrasound. If this test needs to be performed it will be carried out prior to your follow up appointment so that all your results can be given altogether.

 Lifestyle

Stop Smoking- Smoking has been linked to infertility and early menopause in women and has been shown to reduce sperm quality in men. It is also a factor in premature or low birth-weight babies. It may also affect your eligibility for NHS funding for fertility treatment.

A balanced healthy diet is important for your general health as well as fertility. It’s important to aim for a BMI less than 30 (more than 30 may affect your NHS funding eligibility criteria)

www.nhs.uk/livewell/goodfood/pages/goodfoodhome

Folic Acid is important to help your unborn baby's brain, skull and spinal cord develop properly to avoid development problems (called neural tube defects) such as spina bifida. Women should take this before getting pregnant and continue up to your 12th week of pregnancy. You are also advised to take Vitamin D daily. www.nhs.uk/medicines/folic-acid/

Alcohol- the safest approach is not to drink alcohol at all to keep risks to your baby to a minimum. Drinking too much alcohol can also affect the quality of sperm (UK Chief Medical Officers recommend adults should drink no more than 14 units of alcohol a week, which should be spread evenly over 3 days or more)

Useful Info

• www.nhs.uk
• www.hfea.gov.uk

 

Document Code: P-INFO-GEN-73	Version No: 2	Document Title: Hewitt Fertility Screening Clinic Patient Information Leaflet
Date of issue: 15.02.2024	Date of review: 15.02.2026	Owner: J.D

The Welfare of the Child

The leaflet is detailed below, or you can download the 'The Welfare of the Child' leaflet in PDF

The Welfare of the Child

A woman shall not be provided with treatment services unless account has been taken of the welfare of any child who may be born as a result of treatment (including the need of that child for supportive parenting), and of any other child affected by the birth.' (HFE Act 1990)

 As a licensed unit, we are required by law to satisfy ourselves that we know of no medical or social reason why an individual or couple may not be offered treatment, including anything that may adversely affect the welfare of any resulting child.

We make our enquiries by asking patients to complete a welfare of the child form. If necessary, we may need to make further enquiries by contacting the patient's GP or other third parties. To do this, the patient's written consent must be obtained and refusal to give consent may be taken into account. If our enquiries give cause for concern, the centre will make any further enquiries of any relevant authority or agency. On rare occasions treatment may be refused on clinical grounds if the unit believes that it would not be in the best interests of any resulting or existing child to provide treatment.

Patients are encouraged to give their views before any decision is made and to meet any objection raised to providing them with treatment. In certain situations, a case may be referred to the Ethics Committee. This is an independent body of professional and lay people who meet regularly. They have a responsibility to ensure that the patient's treatment, taking into account their circumstances, is ethically acceptable.  People seeking treatment are entitled to a fair and unprejudiced assessment of their situation and needs. This is conducted with skill and sensitivity appropriate to the delicacy of the case and the wishes and feelings of those involved.

Legal Parenthood

Legal parenthood and legal responsibility

A person recognised as the legal parent of a child may not automatically have parental responsibility. Legal parenthood gives a lifelong connection between a parent and a child, and affects things like nationality, inheritance, and financial responsibility. The legal parent normally has parental responsibility.  A person with parental responsibility has the authority to decide about the care of the child while the latter is young, for example for medical treatment and education.

A child’s legal mother automatically has legal parenthood. The position of the partner depends on factors including their marital status, what is recorded on the birth certificate; and for intended parents in surrogacy agreements whether the family court has made a parental order.

Legal parenthood for recipients of sperm or embryo donation

Heterosexual couples:

When donor sperm or embryos are used for treatment, the Human Fertilisation and Embryology Act 2008 states that if heterosexual couples using donor sperm or embryos are unmarried, the male partner must consent to being the legal parent to be legally recognised as such and be named on the child's birth certificate. The female patient receiving treatment also needs to consent for her partner to be the legal parent. For married couples the husband is the legal father of the child.

Same sex couples::

When lesbian couples who are not married or not in a civil partnership are treated, it will be possible for the female partner of a woman who has a child following IVF, or donor insemination, to be the child's second legal parent. The female partner must consent to be the child's second legal parent in order to be legally recognised as such and be named on the child's birth certificate. The woman being treated must consent for her partner to be the child’s second legal parent to be legally recognised as such and named on the child’s birth certificate. The appropriate parenthood forms are required to be completed before treatment.

The status of lesbian couples who are civil partners is that of married couples, the civil partner or wife will be the legal parent of the resulting child.

There is a difference in law between the legal status of 'parent' and having 'parental responsibility' for a child. Should you have any concerns regarding this, please contact a member of the counselling team on 0151 702 4075 or hewittcounsellingservices@lwh.nhs.uk, or if required seek your own legal advice.

 

Document Code: COUN-INFO-P-5	Version No:1	Document Title: The Welfare of the Child and Legal parenthood
Date of issue:12/12/2023	Date of review: 12/12/2023	Owner: R Gregoire	Author: P Lambert

 

 

Freezing and Storage of Sperm Prior to Fertility Treatment

The leaflet is detailed below, or you can download the 'Freezing and Storage of Sperm Prior to Fertility Treatment' leaflet in PDF.

Why is my sperm sample being frozen?

Sperm freezing, also known as sperm cryopreservation, is typically offered for the following reasons;

• Retrograde ejaculation, where the sperm is passed into the bladder instead of passing out through the urethra.
• If you have difficulty with or concerns about producing a sperm sample on the day of treatment.
• If the quality of your sperm sample is such that we have concerns that there may not be an adequate number of sperm to perform your ICSI treatment on the day of egg collection.
• Social reasons. For instance, not being available when your semen sample will be required during fertility treatment.
• Fertility Preservation (see separate patient information leaflet)

The Hewitt Fertility Centre will want to make sure we have sperm to use when fertility treatment starts. Frozen sperm samples can be thawed when required and used in procedures such as artificial insemination (IUI), in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Freezing your semen sample before fertility treatment will help maximise the chance of this being the case.

I’ve been asked to freeze my sperm, what happens next?

 

If your doctor has recommended sperm freezing, you will first have a blood test where we screen for HIV, Hepatitis B & C. This is for sperm storage purposes as there is a theoretical risk of viral cross-contamination between samples.

 

Once the results of the blood test become available, The Andrology Team at Hewitt Fertility Centre will then telephone you to arrange an appointment date and time to visit the centre and store your sperm. The appointment made will be before further treatment is due to begin (IVF,ICSI or IUI treatment).

 

On your sperm freeze appointment date, you will first have a consultation with a Reproductive Scientist to discuss the implications of storing your sperm and complete the relevant consent forms. You will be asked questions with regards to the storage and use of stored samples. At this appointment, you will have the opportunity to ask any questions you might have.

Next, you will be asked to produce a semen sample through masturbation. The centre has private, specially designed, soundproof production rooms available for you produce your sample in. In some circumstances, it may be possible to produce your sample at home, provided it is delivered to the centre within one hour of production.

What happens to my sperm once I’ve produced a sample?

Once you have produced your sample, it will undergo a semen analysis test to quantify the quality of the sample. Your sample will then have cryoprotectant added (a liquid media that prevents damage to sperm cells during freezing) before being transferred into a number of ‘sperm straws’. The straws are gradually cooled to -196°C. Once cooled, your sample will be placed into special containers called dewars, where they will be kept in liquid nitrogen or liquid nitrogen vapour until you potentially require them for fertility treatment.

Have I produced enough sperm and what is its quality like?

The Andrology Team at The Hewitt Fertility Centre will ensure that enough of your sperm will be frozen for future fertility treatment(s). This may involve attending the centre up to two further times. We will know whether further appointments will be needed after you have produced your first sample and will arrange this with you. If your sample is unsuitable for storage, you can discuss your options and next steps with your clinician. You are welcome to use our counselling service if you wish to do so.

What are the legal implications for storing sperm?

All fertility centres are under the regulation of the Human Fertilisation and Embryology Authority (HFEA). Prior to freezing and storing sperm, it is a legal requirement that you give written consent concerning;

• Storage of your sperm and the length to which it is stored for
• The circumstances to which your sperm can be used in the future (you may have a partner with whom you wish to have a family named on your form)
• Your decision over any embryos created using your sperm
• What happens to your frozen sperm in the event of your death or incapacitation

You are free to withdraw or vary the terms of your consent at any time. You should be aware that in the event of your death, you can have your name registered as the parent of any child or children born because of using your sperm, provided you have consented to this in writing. If your circumstances change, for instance you move address, change telephone number, or separate from your partner at the time of storage, it is vitally important that you make the Hewitt Fertility Centre aware of these changes immediately.

How long can sperm be stored?

The legal period for storing sperm is 55 years according to the HFEA. However, crucially for storage to lawfully continue you will need to renew your consent every 10 years. It is unlawful to store sperm beyond the period to which you consent, and the Hewitt Fertility Centre has a legal obligation to dispose of your sample once consent has expired.

Do I have to pay for freezing & storing my sperm?

This is dependent upon which NHS Integrated Care Board you fall under and what specific criteria they have set for funding sperm storage. This will be assessed before you freeze sperm. If you qualify for NHS funding, sperm storage is typically funded by the NHS for 10 years.

When funding for storage ends, you will be contacted by the Hewitt Fertility Centre to ask whether you wish to continue storage up until the length that you have legally consented for. Continued storage after this period, will incur an annual fee.

If you do not qualify for NHS funding, sperm freezing and storage incurs a fee.

How successful is the use of frozen sperm?

We would expect around 50 to 75% of your frozen sperm sample to survive the thawing procedure. Treatment using frozen sperm has a similar success rate to treatment using fresh sperm. Please note, success rates are partly dependent on sperm quality.

Safety & Quality

We promise to look after your sperm as carefully as possible but we cannot be held responsible for its safety or the risk of the loss of sperm due to equipment failure. In addition we cannot guarantee your sperm will survive the freeze-thaw process or that a successful pregnancy will result from its use.

The Lewis-Jones Andrology Department at the Hewitt Fertility Centre has provided a dedicated Andrology service for over 30 years. We are attached to the Hewitt Fertility Centre HFEA licensed centre 0007) and can provide all fertility treatments potentially required in the future. We also have a centre at Knutsford (Centre number 0344) where the same care can be provided if more convenient and appropriate.

Contact with the unit

Please feel free to contact the laboratory on 0151 702 4214 or email lwft.andrologylab@nhs.net if you require any further information about fertility preservation.

You must keep us informed of any change in your circumstances e.g. change of address. This is because we will contact you every three years to see if you still want your sperm to be stored. If we are unable to contact you, your samples will be destroyed when they reach the end of their statutory storage period. If you have any questions on sperm storage, please contact the unit and ask to speak to a member of the Andrology team.

Document Code: P-INFO-FP-2	Version No: 5
Document Title: Freezing and Storage of Sperm Prior to Fertility Treatment
Date of issue: 15/09/2022	Date of review: 15/09/2025
Owner: H Newby	Author: R Byrne

 

 

Surgical Sperm Retrieval (SSR)

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

Why do I need surgical sperm retrieval?

Surgical sperm retrieval (SSR) is a treatment option for men who have no sperm (Azoospermia) in their ejaculate. Reasons for undertaking (SSR) could include:

Obstructive Azoospermia – An obstruction preventing sperm release from the testicle due to previous injury or infection, or Congenital Absence of the Vas Deferens (tube carrying sperm from testis) in men with Cystic Fibrosis, or Vasectomy.

Non-obstructive Azoospermia – Likely testicular failure where the testicles are producing low numbers of sperm which are not found in the ejaculate. This could also be associated with genetic conditions.

Other possible clinical indications may be for men with erectile dysfunction and retrograde ejaculation.

 What are the different techniques of SSR?

There are different methods of SSR. The cause of your Azoospermia will determine the best way to retrieve sperm in your individual case.

 TESE (Testicular Sperm Extraction)

This is often done under general anaesthetic. A 0.5cm incision is made into the testis itself. A small sample of the testicular tissue is taken which is then examined for sperm. This is usually carried out if the male hormone levels and testicular size are normal.

Micro-TESE (Microscopic Testicular Sperm Extraction)

This requires a general anaesthetic and involves performing a 2-3 cm incision on the scrotal skin. The testis is opened and several biopsies are taken from each testicle in different areas and by using an operating microscope, some of the fine individual sperm producing tubes are removed for detailed assessment. The sample is transported to the Andrology department by a responsible adult of patient’s choice to the Hewitt Fertility Centre for detailed examination, and storage of sperm if found.

How long will I be in hospital?

SSR is a day case procedure. When done under general anaesthetic, it usually takes 3-4 hours to recover and then you are discharged home. The material collected will be examined on the same day. To increase the likelihood of finding sperm, the sample is cultured in medium by the embryology team. Any material with sperm will be frozen and placed in storage to be used in assisted reproduction treatment cycle(s) at a later stage. These specimens are then thawed and used to inject mature eggs obtained during in-vitro fertilisation (IVF) treatment using the technique of Intra-cytoplasmic Sperm Injection (ICSI).

What will happen after the procedure?

Potential side effects post procedure may be some testicular discomfort and mild bruising.

The sedation or anaesthetic will wear off following the procedure, however a responsible adult will need to drive you home. You should try to have a relative stay with you for the first 24 hours after surgery.

You will need to rest until the effects of the anaesthetic/sedation have passed. Your scrotum will feel sore as the anaesthetic wears off and you may need painkillers. You will be wearing supportive underwear from the day of procedure and scrotal support (jock strap) daily for a further 5-6 days to minimise discomfort and protect your scrotum and testes. If you need pain relief, you can take over-the-counter painkillers such as Paracetamol or Ibuprofen.  Showering is advised; try to avoid hot baths to prevent infection. Dissolvable sutures take about 2 weeks to come away.

Further advice includes:

• Avoid alcohol for 48 hours post-surgery. Refrain from strenuous exercise/lifting for four weeks.
• There are no stiches that need to be removed.
• Sexual activity is not advised for a week after the procedure.
• During the procedure you will be given antibiotics

Are there any complications?

SSR is a relatively low risk procedure. Most men do not experience side effects.

Possible complications include:

• bruising
• haematoma (collection of blood in scrotum)
• minimal scarring
• infection
• damage to blood vessels - this can cause permanent damage to one or both testicles (testicular atrophy - rare).
• long-term testicular pain (5-10%) - this is caused by damaged nerves or scarring and may require long term pain medication.
• anaesthetic side effects - postoperative nausea and vomiting (usually lasts for 1-2 hours and can be controlled with anti-emetic medications). Very rarely anaphylaxis, a severe reaction, (risk is 1 in 10,000).

How effective is SSR?

Obstructive cases are usually more successful than non-obstructive. The sperm which is successfully retrieved is frozen and this does not affect its ability to subsequently fertilise an egg. However the sperm retrieved is usually low in numbers and may not be mature therefore cannot successfully fertilise an egg using standard IVF. Because of this, the embryologist will pick out a single sperm to inject into each mature egg (this procedure is called Intracytoplasmic Sperm Injection or ICSI).

 

Document Code: P-INFO-MED-9	Version No:2	Document Title: Surgical Sperm Retrieval PIL
Date of issue: 08.11.2023	Date of review: 08.11.2026	Owner: A Drakeley	Author: R Byrne

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

Background

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

What happens to my unused sperm, eggs and embryos? 

The leaflet is detailed below, or you can download the 'What happens to my unused sperm,eggs and embyros' leaflet in PDF.

As a clinic we strive to give you the highest standard of care possible. In order for us to achieve this, we use surplus, donated eggs, sperm and embryos that are not suitable for treatment in the following ways:

1. To train new members of our laboratory team
2. To continuously update the skills of our experienced laboratory team members

The performance of this training not only allows us to maintain high success rates, it also allows us to continuously improve the services that we offer. During your treatment at the Hewitt Fertility Centre you may be required to complete a number of consent forms issued by our governing body, the HFEA. These consent forms will ask you whether you are willing for your surplus eggs, sperm, and embryos to be used for training purposes. The aim of this leaflet is to explain what this process involves so you can make an informed decision as to whether you are happy to be involved in our training programme.

Eggs remaining after your fertility treatment

Not every egg is able to create an embryo. For example, immature eggs cannot undergo fertilisation and some mature eggs are unable to complete the fertilisation process or may exhibit abnormal fertilisation. In all these situations, the eggs are unable to create an embryo and therefore cannot be used in your treatment. These are known as non-viable eggs, and we only ever use non-viable eggs for training purposes. Viable eggs, that have the potential to create a pregnancy, are always used as part of your treatment and are never used for training. Training eggs are typically used by trainee embryologists as they learn how to master technically complex laboratory procedures. It is important to note that your training eggs will never be mixed with sperm during the training period.

Sperm remaining after your fertility treatment

During IVF treatment, eggs are mixed with approximately 100,000 sperm whereas during ICSI treatment, each mature egg is injected with one sperm. It is therefore relatively common for ‘surplus’ sperm to remain following the performance of the IVF or ICSI procedure. Surplus sperm samples can be used for training purposes. Our embryologists typically use training sperm to develop and refine their sperm handling skills. Your sperm will never be used in training until after your IVF and ICSI treatment has been performed.  Your surplus sperm will never be mixed with eggs during the training period.

Embryos that cannot be used for your fertility treatment

We carefully analyse all the embryos that are created within the laboratory. Any good quality embryos that are created as part of your treatment will either be transferred to your womb in a fresh treatment cycle, or frozen for your use in a future frozen embryo transfer. Any poor-quality embryos would normally be discarded as they would be unable to create a pregnancy. However, these non-viable embryos can be used for training as they provide our embryologists with the opportunity to develop the intricate laboratory skills needed to culture embryos in a safe and efficient manner.

What happens to my surplus frozen eggs, sperm and embryos?

If you have come to the end of your fertility journey and have surplus frozen eggs, sperm or embryos which you wish to remove from storage, you will be given four options at this time on what you would like to happen to them. 

1. Donate to research
2. Donate to training at the Hewitt Fertility Centre
3. Donate to another patient
4. Discard your egg(s)/sperm/embryo(s)

If you have frozen samples in storage and have come to the end of your storage period, you will be required to fill in new consent forms which give you the option to:

1. Renew your consent to storage for your own treatment up to a further 10 years
2. Withdraw your consent to the storage of your samples, with option to:
   1. Completely withdraw your consent to storage and dispose of your samples
   2. Withdraw your consent to storage for treatment and donate your samples for training, which can remain frozen for up to a total of 55 years from the freeze date.

Please note, during your fresh cycle, training samples will never be cultured in the laboratory for longer than 7 days and all samples will be safely discarded at the end of the training period. The laboratory team would be extremely grateful if you could consider whether you would be happy to be involved in our training programme. You will have the opportunity to specify on your consent forms which samples can be used for training purposes. For example, you may be happy for your non-viable eggs to be used in training but not your surplus embryos. You will not be informed of how your eggs/sperm/embryos have been used in training, but we are happy to answer your questions if you are interested.

You can change or vary your consent at any time prior to your sperm, eggs or embryos being used in training. Please be reassured that the decision you make regarding the use of your sperm, eggs or embryos in training will not affect your treatment in any way. Gametes and embryos utilised in training are not anonymised and therefore if you have any questions regarding the use of your eggs, embryos, or sperm in training, please feel free to ask a member of the embryology team and we would be happy to discuss the process further with you. Please note that if we have accepted your egg(s), sperm, or embryo(s) for training and we no longer require them, or they are not suitable for training, we may opt to dispose of them prior to the end of the storage consent period. Please note it is unlikely that training will reveal any information relevant to your health or welfare. If relevant information does become available and you would like to be informed, please make our staff aware when completing consents. If you have any questions about this, please contact us.

 

Document Code: P-INFO-GEN-54	Version No: 8	Document Title: What happens to my unused eggs, sperm and embryos?
Date of issue: 02.08.2023	Date of review: 02.08.2025	Owner: R Gregoire	Author: R Howard

The leaflet is detailed below, or you can download the 'Multiple Pregnancy Patient Information' leaflet in PDF

Multiple Births and the Hewitt Fertility Centres ‘elective single embryo transfer’ program

When you’re going through fertility treatment, you’re understandably focused on getting pregnant and may think that having two embryos transferred to the womb will increase your chance of making that happen. But did you know that putting more than one embryo back in the womb can increase the risk of serious harm to you and your babies?

Twins might seem like a dream come true – an instant family; plus we all know people who have had wonderful, happy, healthy twin babies. However, the reality is multiple births are the single greatest risk of fertility treatment. At least half of twins are born premature and underweight, which can lead to serious long-term health problems such as cerebral palsy and can even lead to death. Mothers are far more likely to have an early or late miscarriage if they are carrying multiple babies. And they are more likely to suffer from health problems such as high blood pressure, gestational diabetes, anaemia and haemorrhage than mothers of single babies.

You can significantly reduce your chance of having a multiple birth by having one embryo put back in the womb rather than two - called elective single embryo transfer or eSET. You can then have your remaining embryo(s) frozen for use in later cycles. Transferring embryos as part of a frozen cycle is often as effective as transferring them fresh. For most women having IVF, transferring one embryo is equally as successful as having a double embryo transfer and your chance of having a multiple pregnancy is much lower. Transferring one embryo is the best option for most women to maximise your chances of taking home a healthy baby. 

We want to provide you with safe and effective fertility treatment. That’s why we recommend an eSET unless we have good reasons for recommending a double embryo transfer.

Our regulators the Human Fertilisation and Embryology Authority (HFEA) have a policy that all UK clinics must maintain a multiple birth rate limit of less than 10% but maintain our high clinical performance. Our most recent success rates are available on our website.

 

https://www.thehewittfertilitycentre.org.uk/our-success-rates/

 

 

Risks to you in a multiple pregnancy

While most multiple pregnancies are healthy and result in healthy babies, there are more risks to be aware of when you are pregnant with two or more babies. Make sure you go to all your antenatal appointments so that any problems can be picked up early and treated appropriately.

If you are pregnant with more than one baby, you are at higher risk from all the complications associated with pregnancy and birth: 

• You have a higher risk of miscarriage, anaemia, haemorrhage, early labour, caesarean section or assisted ventouse or forceps delivery
• Up to 25% of multiple pregnancies will be complicated by pregnancy related high blood pressure
• The risk of pre-eclampsia is three times higher for twin pregnancies and nine times higher for triplets
• You are two to three times more likely to have gestational diabetes
• Multiple pregnancies are likely to have a practical, financial and/or emotional impact on your family and any pre-existing children.

Risks for babies in a multiple pregnancy

• Half of all twins are born prematurely (before 37 weeks) with a low birthweight (2.5kg or under); triplets have a 90% chance of being born prematurely and of having a low birthweight
• The risk of death for premature babies around the week of birth is 5 times higher for twins and nine times higher for triplets than single babies
• Twins have a higher risk of congenital abnormalities (birth defects), developmental delay and brain injury and breathing/lung damage
• Twins are 4 times and triplets 18 times more likely to have cerebral palsy than single babies
• Twin to Twin Transfusion Syndrome (TTTS) is a rare condition affecting identical twins who share a placenta (monochorionic). The risk is higher for MCDA twins, but it can occur in MCMA twins too. It is caused by abnormal connecting blood vessels in the twins’ placenta. This results in an imbalanced blood flow from one twin to the other, leaving one baby with a greater blood volume than the other and carries a higher risk of fetal death. Treatment for TTTS varies and is determined by many factors. It's important to discuss it with your consultant, as what works in one TTTS pregnancy may not be appropriate in another.

What antenatal care can I expect if I do get pregnant with twins?

Good antenatal care is essential because there are increased risks associated with a multiple pregnancy. When you see your midwife for your initial antenatal appointment you will be referred to an obstetric team with expertise in multiple pregnancies.

Read more at this website:-

http://www.nhs.uk/conditions/pregnancy-and-baby/pages/twins-healthy-multiple-pregnancy.aspx

 

Document Code: P-INFO-MED-2	Version No: 9	Document Title: Multiple births
Date of issue: 13.12.2023	Date of review: 13.12.2026	Owner: R Russell	Author: M McGrane

 

 

Complications of Fertility Treatment 

The leaflet is detailed below, or you can download the ' Complications of Infertility' leaflet in PDF.

Some infertility treatments can cause complications, these include side effects from medication, multiple pregnancy and stress.

Side effects of medication

Some medications used to treat infertility can cause side effects. These may include:

• nausea
• vomiting
• diarrhoea
• stomach pains 
• headaches
• hot flushes
• skin sensitivity reactions and bruising around the injection sites
• hormonal related mood changes

For a full list of possible side effects, please see the patient information leaflet that comes with your medication.

Ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) can occur after taking medicines that stimulate your ovaries, such as clomiphene and gonadotrophins, and can develop after in-vitro fertilisation (IVF). OHSS causes your ovaries to swell and produce too many follicles (small fluid-filled sacs in which an egg develops).

Around one-third of women will experience mild OHSS after one cycle of IVF. Less than 5% will develop moderate or severe OHSS after one cycle of IVF. 

Mild symptoms may include:

• nausea 
• vomiting
• abdominal pain 
• bloating
• constipation (when you are unable to empty your bowels)
• diarrhoea
• dark, concentrated urine

Severe OHSS is a potentially life-threatening condition and can lead to:

• thrombosis (a blood clot in an artery or vein)
• liver and kidney dysfunction
• respiratory distress (difficulty breathing)

You should seek medical attention immediately if you experience any of the symptoms of OHSS.

You may need to go to hospital so that your condition can be monitored and treated by healthcare professionals.

Ectopic pregnancy

"Ectopic" means in the wrong place. An ectopic pregnancy occurs when the embryo implants outside of your womb. More than 95% of ectopic pregnancies occur in the fallopian tubes.

If an embryo implants in your fallopian tube and continues to grow, it can result in tubal rupture which is a potentially life-threatening event. Signs of an ectopic pregnancy include:

• pains low down in your stomach
• vaginal bleeding

Please inform The Hewitt Fertility Centre if you experience either of these symptoms early in your pregnancy. Alternatively, you can contact the Emergency Room at the Liverpool Women’s Hospital for further advice.

If you are receiving fertility treatment, your chance of having an ectopic pregnancy is around 3%. This is higher than the usual rate of ectopic pregnancies, which is around 1%. You may be more likely to have an ectopic pregnancy if you have already had problems with your fallopian tubes.

Pelvic infection

The procedure to extract an egg from an ovary may result in a painful infection developing in your pelvis. However, the risk of serious infection is very low. For example, there is likely to be less than one serious infection for every 500 procedures performed.

Multiple pregnancy

Having more than one baby may not seem like a bad thing, but it does significantly increase the risk of developing complications for both you and your children. Multiple pregnancy is the greatest health risk of fertility treatment.

Possible complications of multiple pregnancy include:

• Babies born prematurely or with a low birth weight – this affects 50% of twins and 90% of triplets.
• Your baby dying within the first week of life – the risk of this happening is five times higher for twins, and nine times higher for triplets, than for a single baby.
• Your baby having cerebral palsy (a condition that affects the brain and nervous system) – the risk of this happening is five times higher for twins and 18 times higher for triplets than for single babies.
• High blood pressure (hypertension) during pregnancy – this affects up to 25% of women who are carrying more than one baby.
• Developing diabetes during the pregnancy (diabetes is a condition caused by too much glucose in the blood) – the risk is two to three times higher for women carrying more than one baby than it is for those carrying a single baby.

In the UK, the number of multiple births from IVF treatment is 6%, this is higher than the usual rate of multiple pregnancy, which is around 2%.

Stress

Infertility can be stressful and strain relationships. It may be helpful for you to join a support group where you can talk through your feelings with others who may be experiencing similar issues.

Finding out you have a fertility problem can be traumatic and many couples find it helpful to talk to a counsellor. The counsellor will be able to discuss treatment options, how they may affect you and your emotional wellbeing. Your GP should be able to refer you to a counsellor as part of your fertility treatment.

http://www.nhs.uk/conditions/infertility/pages/complications.aspx

 

Document Code: P-INFO-MED-1	Version No: 7	Document Title Complications of Fertility Treatment
Date of issue: 05.02.2024	Date of review: 05.02.2025	Owner: A Drakeley	Author: N Tempest

 

 

Choosing your best embryos

The leaflet is detailed below, or you can download the ' Choosing your best embryos' leaflet in PDF.

Why do we need to choose embryos for transfer or freezing?

Most patients will produce more than one embryo during their treatment cycle but we know that not all embryos will become babies – this is nature’s way of making sure that only the ‘best’ or ‘fittest’ embryos become babies. 

Is it obvious which embryos are the best?

Not always. Sometimes it is very difficult to tell which embryos are the best, particularly when embryos are only three days old as several embryos from the same patient may look very similar at this stage. This photograph shows six embryos that all look very similar (two days after egg collection) from the same patient. I’m sure you’ll agree that it would be difficult to choose one or two embryos based only on their appearance!

Is there a way of choosing the best embryos?

Yes. If you have a number of embryos to choose from that all seem to be of similar quality, we suggest that we allow all your embryos to continue to grow in the laboratory for five days after egg collection. What usually happens is that the ‘best’ embryos will continue to grow (to become something which is called a blastocyst) whereas those that were never destined to become babies will ‘fall by the wayside’ and stop growing. You might like to think of this as the ‘best’ embryos selecting themselves or ‘survival of the fittest’.

What is a blastocyst?

A blastocyst is the name given to an embryo when it is about 5 or 6 days old. You can see a blastocyst in the photograph on the left. The part of the blastocyst labelled ‘A’ is the called the trophectoderm and will form the cells of the placenta. The part of the blastocyst labelled ‘B’ is called the inner cell mass and will form the baby.

Does everyone have their embryos grown to the blastocyst stage?

 No. If you only have a small number of embryos then it may be possible to select your embryo three days after your egg collection.  The Embryologist will advise you on the best day for transfer during your treatment. 

Does growing my embryos to the blastocyst stage increase my chances of getting pregnant?

Possibly. There is some evidence available to suggest that blastocyst transfer may improve your chances of getting pregnant as the embryo has displayed its ability to develop. Your chance of getting pregnant is determined by many factors, including embryo quality, thickness of the endometrial lining (and its receptivity) in addition to your age. Your chances of pregnancy can be estimated by a doctor when considering all of these factors.

Are there any risks in keeping embryos to the blastocyst stage?

There is no strong scientific evidence that growing embryos to the blastocyst stage in the laboratory before they are transferred is harmful to the baby in any way. If you have a small number of embryos, there is a risk that none of the embryos will develop to the blastocyst stage resulting in no embryo transfer and/or embryo freezing. We use our clinical judgement to decide whether you are suitable for blastocyst culture. It is important to understand that poor embryo development is a risk that is present for anyone undergoing IVF treatment.

 

Document Code: P-INFO-GEN-2	Version No: 9	Document Title: Choosing Your Best Embryos
Date of issue: 23.11.2022	Date of review: 23.11.2025	Owner: R Lunt	Author: R Howard

 

 

Counselling at The Hewitt Fertility Centre

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

Fertility problems and their treatment can leave you feeling stressed, anxious or depressed and affect your close relationships. It’s quite common for people in this situation to have feelings of guilt about themselves, anger and jealousy towards others, and to feel a lack of control over what is happening. It can be difficult to share your thoughts and feelings with family and friends as they may not understand what you’re going through, or they might not be aware that you have a fertility problem. Relationships between partners can become strained if trying for a much-wanted baby is unsuccessful.

If any of this applies to you, it may help to talk things through with one of the Centre’s counselling team. We aim to provide you with a safe environment where you can freely explore your thoughts and feelings. We can also offer simple ideas for coping with stress and anxiety. The team is led by Patricia Lambert, our Senior Counsellor. We are all trained in counselling and are members of the British Infertility Counselling Association (BICA). We are not medical staff, but we do have an understanding of fertility problems and the various treatments provided for them. Counselling is available before, during and after treatment, regardless of the outcome. Counselling sessions usually last for an hour. The number of sessions you have will be decided between yourself and your counsellor; there is no pressure to continue with sessions if you feel they are not helpful. Some people just attend one session, some attend as and when they feel they need to and others have more regular appointments. Counselling is available for individuals or couples. We will be as flexible as we can with our appointments and try to arrange them at times to suit you. We can offer face to face or online sessions.

You may be worried that seeing a counsellor before your treatment starts or during a course of treatment will reflect badly on you and affect your ability to continue. This is not the case. We are not here to judge your suitability for fertility treatment. With very few exceptions (for example when someone is at risk of harm) counselling sessions are confidential and we do not share the details of them with anyone, including other members of clinic staff. We make notes of our sessions, but they are kept separately from clinic notes and no-one else sees them. We can explain more about confidentiality when you meet us for the first time.

If your treatment is funded by the NHS, there is no charge for counselling. Self-funding patients have two sessions of counselling included in the cost of their treatment; any further appointments are subject to a fee. For most of our patients counselling is an option they can choose to take up if they wish. Under certain circumstances you may be required to see a counsellor before your treatment continues, for example if treatment will involve the use of donated sperm, eggs or embryos or surrogacy. This is to ensure you understand all the implications of this course of action, both for yourselves and any children who may be born as a result.

You can ask any member of staff at the Hewitt Fertility Centre to refer you to the counselling service. You can also contact us directly to make an appointment or find out more about what we can offer by calling 0151 702 4075 or email: hewittcounsellingservices@lwh.nhs.uk

Document Code: COUN-INFO-P-6	Version No:1	Document Title: Counselling
Date of issue:12/12/2023	Date of review: 12.12.2025	Owner: R. Gregoire	Author: P. Lambert