Treatments

Ovulation induction involves using hormonal therapy to stimulate the development and release of eggs. The patient’s cycle can then be tracked to establish the best time to conceive. Ovulation induction can be useful for women who either do not ovulate regularly or do not ovulate at all.

IUI treatment involves taking laboratory prepared sperm and placing it directly into the womb. IUI can be a less invasive treatment compared to IVF, but the patient must have at least one healthy fallopian tube. This approach is also commonly used for donor insemination.

The process of IVF involves collecting eggs from the ovaries and combining them with sperm in the laboratory. The fertilised eggs (embryos) are then cultured for a number of days and then returned back to the womb, in the hope of producing a healthy baby.

ICSI is a slightly modified version of IVF.

Whilst IVF combines eggs and a number of sperm under laboratory conditions, ICSI is a more sophisticated technique which injects the sperm directly into the egg.

ICSI is generally used to treat male infertility and also to help couples who have previously had reduced fertilisation with IVF.

We are able to offer our patients the option of freezing their sperm for a number of reasons, including;

• Sub fertility; your clinician may suggest that you should store your samples prior to your fertility treatment
• Marked decline in fertility
• Pre-vasectomy
• Post-vasectomy reversal
• Armed Forces; you may wish to preserve your fertility or, potentially, you may not be present for your treatment due to deployment
• Sperm donation; donating your sperm can be an incredible gift to help support patients who wish to complete their family.
• Fertility preservation
  • Pre-chemotherapy/pre-surgery
  • Transgender fertility treatment

The above options may be subject to funding criteria and may only be available on a self-funding basis.

Your frozen samples can be stored for a period of up to 10 years. In some cases, if there is the potential that you may become prematurely infertile, the storage period can be extended up to 55 years with a Medical Practitioners Statement.

We are able to offer our patients the option of freezing their eggs for a number of reasons, including;

• Fertility preservation (pre-chemotherapy/pre-surgery)
• Transgender fertility treatment
• Social reasons
• Egg donation; donating your eggs can be an incredible gift to help support patients who wish to complete their family.

The above options may be subject to funding criteria and may only be available on a self-funding basis.

Your frozen eggs can be stored for a period of up to 10 years. In some cases, if there is the potential that you may become prematurely infertile, the storage period can be extended up to 55 years with a Medical Practitioners Statement.

When you have fertility treatment at the Hewitt, we can discuss the possibility of freezing your embryos. This is because, during IVF or ICSI treatment, additional embryos may be produced. If the additional embryos are of a suitable quality and you want these to be stored, we can freeze them for future treatment. We can also freeze embryos for patients that would like to preserve their fertility.

Currently, the law only allows us to keep embryos for 10 years, but this limit can be extended in certain medical circumstances. Whatever your decision, we’ll always be happy to offer help or advice and answer any questions you may have.

Thanks to our purpose-built laboratory we have the ability to treat HIV positive patients. Within this treatment, we offer Sperm Washing Therapy to reduce the risk of potentially passing HIV from the male to the female partner and to the unborn child. The washed sperm is tested for the presence of HIV virus before use in your treatment.

As well as this, our state-of-the-art laboratories allow us to provide fertility treatment for HIV positive women and also patients who are Hepatitis B or Hepatitis C positive.

Surgical Sperm Recovery (SSR) or Testicular Sperm Extraction (TESE) is a surgical technique used to retrieve sperm directly from the testicle. In some cases, due to low sperm numbers or a blockage, sperm cannot be found in the ejaculate, but may be retrieved using this surgical technique. SSR can also be a treatment option following an unsuccessful vasectomy reversal.

Successfully retrieved sperm are frozen and can be thawed and used in your partner’s treatment.

A referral from your GP or Clinician to the Hewitt Fertility Centre would be required to state whether your treatment would be on an NHS or self-funded basis.

Donor insemination involves taking laboratory prepared donated sperm (from a screened HFEA-registered donor) and placing it directly into the womb of the recipient. This process is used worldwide and has resulted in several hundred thousand children being conceived over the past 50 years. This type of treatment can be useful when the male partner is infertile, for single women, or for same sex couples.

Egg donation can be an incredible gift; this involves donating eggs for another patient to use in treatment to start a family. This can be an option for women whose ovaries no longer function (for example due to early menopause or after cancer treatment) or to avoid passing on a genetic disorder.

For this treatment, the donated eggs (from a screened HFEA-registered donor) are fertilised outside the body and then transferred into the womb of the recipient, so she can carry the baby.

The UK has limited availability of donated eggs, which means many women who need donated eggs are unable to access treatment. In addition to this, the cost of IVF means that many women who require IVF treatment are unable to afford it if they do not qualify for NHS funding.

To offer a practical solution, we offer egg sharing at the Hewitt Centre. This is where women who require IVF and are willing to donate some of their eggs to another patient, can access treatment at a reduced cost.

There are two types of surrogacy to consider:

Gestational surrogacy involves the creation of an embryo by the intended parents; this embryo is then placed into the womb of another woman (the surrogate) who carries and gives birth to the baby. The intended parents can then become the legal parents by applying for a parental order after the child is born.

Partial surrogacy (sometimes referred to as traditional surrogacy) involves the surrogate’s own egg being fertilised by the sperm of the intended father. The intended parents can then become the legal parents by applying for a parental order after the child is born.

The EmbryoScope® incubator offers continuous surveillance of embryos in a safe, undisturbed and controlled environment, from which they do not have to be removed for examination. The system takes a photograph every 10 minutes of each embryo, providing up to 140 images per day and creating continuous time-lapse 'moving' images.

Emerging research also suggests that the information collected by the EmbryoScope® can be useful in helping to identify the best quality embryos.

At the Hewitt, we culture all embryos in the embryoscope incubators with no added cost.

You can request a USB memory stick containing video images of your transferred embryo(s); please simply ask a member of the Embryology Team at the time of your embryo transfer.

EmbryoGlue® is a fluid containing the polymer hyaluronic acid (HA). HA is thought to help the embryo ‘stick’ to the uterus and improve implantation. At the Hewitt Centre, we add EmbryoGlue® media to the dish that the embryos are kept in before embryo transfer. We use this at every embryo transfer with no added cost because the Hewitt Centre results suggest that using this solution can improve pregnancy rates.

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. The technique 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.

PGT-A may be beneficial for patients who have a significant number of good quality embryos to choose from, as it can identify the embryos in the group that have the correct number of chromosomes. It may also be useful for patients who have had previous miscarriages; however, further research is required to confirm this.

PGT-M (formally known as PGD) involves testing embryos for the existence of serious inherited conditions. The test involves carrying out a biopsy of each suitable embryo and only embryos that have been tested and found to be free of the condition are placed back into the woman’s womb. PGT-M can now be used to avoid over 600 genetic conditions.

At the Hewitt Centre, we do not currently provide PGT-M as part of our routine testing, but we are exploring the idea of making it a service that we could offer to patients in the future.

IMSI is a slightly modified version of the ICSI procedure. Like ICSI, IMSI is a technique involving the injection of a single sperm into each egg. However, IMSI uses a high-powered microscope that allows the sperm to be observed at a very high magnification (up to 6000 times its original size). This means the sperm can be seen in much more detail, which enables the Embryologist to have more information to select the best sperm.

Current research is inconclusive as to whether IMSI is more effective compared to using standard ICSI for the treatment of male infertility. However, IMSI may be used to help couples who have previously had unsuccessful cycles of ICSI - this includes failed fertilisation and failed implantation.

When a sperm meets an egg, it triggers a process called ‘egg activation’ which initiates the process of fertilisation and embryo development. For some patients, this activation process is deficient, resulting in failed or very poor fertilisation. Artificial oocyte activation is used to help activate the egg and aims to improve fertilisation. This technology may be recommended for patients who have had a cycle of failed fertilisation with ICSI.

There is some evidence that the level of sperm DNA damage may be increased in men who are sub-fertile. Therefore, sperm DNA damage testing can be performed to give the patient more information about their sperm sample. The test is a non-invasive procedure performed on a semen sample, usually before treatment as an additional diagnostic test. This test offers a possible further explanation into un-explained infertility and assists the clinicians in selecting the most appropriate treatment type for you and your partner.

Before IVF treatment, a procedure called endometrial scratching can be carried out. This procedure involves creating a small scratch in the lining of the womb. The theory behind this is that the scratch triggers the body to release chemicals and hormones that can make the womb more receptive to an embryo. Endometrial scratching may be recommended for patients who have had a number of previous failed IVF or ICSI cycles. However, the evidence for endometrial scratching is still inconclusive as to whether the treatment can improve pregnancy rates.

• The ERA test of implantation receptivity is based on the theory that for some patients, replacing an embryo either a day earlier or later may be associated with better results. For the test, a biopsy of the endometrium is taken and sent for analysis to decide the most suitable time to transfer an embryo for that specific patient.
• The EMMA test looks at the levels of healthy bacteria that are present in the endometrium. Depending on the result, probiotic treatment may be suggested for the patient to balance the endometrial flora, with the main aim of improving the pregnancy prospects.
• The ALICE test checks for 8 potentially harmful bacteria to an implanting embryo, for which antibiotics may be given.

Endome Trio testing involves all three tests explained above. These tests are considered to be experimental treatments, as evidence is still inconclusive as to whether they can improve pregnancy rates. Therefore, these tests are currently offered at a non-profit price to patients.

In normal embryo development, the embryo hatches out of its outer shell to implant into the womb. Assisted hatching in the laboratory involves using a laser to create a small hole in the outer shell of the embryo, in the hope to assist the embryo’s ability to hatch fully and implant, therefore improving pregnancy rates. Some evidence suggests that this treatment may be beneficial for older patients and patients with a lower chance of successful treatment. However, the evidence for this technique is still not conclusive as to whether it can improve pregnancy rates. Furthermore, many embryos have the ability to naturally hatch during their growth in the laboratory, so this added procedure may not be useful for all patients.

Preparing the body and mind is a crucial part of the journey towards successful fertility treatment and pregnancy. Acupuncture involves the insertion of needles into the skin at specific points on the body, with the aim to improve general wellness, stress management and the feeling of relaxation. We offer acupuncture services at both the Liverpool and Knutsford sites and appointments are available at times to fit around clinic appointments. Acupuncture can be offered at various stages of treatment including preparation for treatment, during treatment, at embryo transfer and post-embryo transfer. Although the Hewitt Centre is aware that the evidence is still inconclusive regarding clinical benefits, the main aim of our acupuncturists is to support patients through their fertility journey.