Our approach to fertility treatment

We have decades of experience treating couples with subfertility and miscarriage problems. We are up to date with the latest advances in tests and treatments and whilst evidenced based, are not bound by restrictions sometimes found in the NHS. An honest discussion on the pros and cons on all aspects of your care will be had at an early stage.

Typically 80% of fertile couples will have achieved a pregnancy after one year of unprotected intercourse. However you can found out how fertile you are at any age. This especially applies to older females, typically stated at >35 years of age.

Female factors include advancing age, a lack of ovulation (egg release), Fallopian tube damage and anatomical factors such as ovarian cysts. Male factors include reduced sperm quality: count (numbers), motility (how far and fast they swim) and morphology (shape of sperm head).

Miscarriage is the commonest complication of pregnancy. The incidence increased with advancing female age and is often attributed to genetically abnormal embryos implanting. The likelihood of miscarriage is around 12% at age 30, 25% at 35, 35% at 40 and 48% for >42 years. Recurrent miscarriage is typically described as 3 or more miscarriages, but is often tested sooner e.g. 2 good quality blastocysts failing to succeed, late miscarriage (12-24 weeks) and fetal losses (heart beat seen on scan).

Different factors influence this. Healthy males produce better quality sperm. Younger, healthy females better eggs, which result in more, better quality embryos. Uterine factors are also important. So exploring factors at every step of the pathway is important and could be the marginal gain needed to succeed. Often persistence pays off as cumulative live birth rate increased with each treatment taken.

After booking a consultation, you will be sent a history sheet (type of questionnaire) to complete. Once returned, you will see a staff member to advise which tests are needed next to give an informed decision. If you have already had some tests in the last year, providing these results will save time and cost.

A staff member will review your history, go over and interpret your test results, sometimes suggest specialist tests and form a management plan with you. This can either be conservative (try longer), medical (tablets) or surgical e.g. hysteroscopy (telescope into the uterus) or laparoscopy (telescope into the abdomen). These can either be arranged at private hospitals or a relevant referral letter to your local hospital for NHS listing are both possible.

Understanding what is stopping you conceive or carry a pregnancy successfully is key to our management approach.

Starting with health advice, dietary improvements, food supplements, oral ovulation induction (help you release eggs), cycle monitoring for artificial insemination, assisted conception (IVF/ICSI), egg or sperm donation, surrogacy work up.

If a woman is not producing her own eggs, the oocyte yield in IVF is low or results in a few poor quality embryos, then egg donation is often beneficial. The live birth rate at 42 is 10%, whereas at 30 with donor eggs it is 50%. Donor sperm is needed for single women, same sex females or when the male partner is not producing his own sperm.

In the UK, donors of eggs, sperm and embryos are identifiable. There is a central registry of who has donated to who? If a child knows they are conceived via donation, they have the right when they are 18 to contact the HFEA to ask who their biological parents are? Donors in the UK cannot be paid, but can be re-imbursed reasonable expenses, which is capped at £750. In other countries such as Spain, donors are anonymous and retain the right to this. This means that children and parents of donor conceived children cannot track the biological sperm or egg provider. Donors can be paid. As such waiting times abroad are often far shorter than the UK.

HFEA stands for the Human Fertilisation and Embryology Authority and is the regulator of fertility clinics in the UK. You need an HFEA licence to provide treatments such as artificial insemination and in vitro fertilisation. A satellite clinic needs to be named on a clinic’s HFEA licence to conduct parts of such treatments.

We are based in Liverpool, but due to our set up are ideally placed to help couples across the UK for fertility and miscarriage testing and early treatment advice. We have satellite arrangements for more advanced treatments with HFEA licensed clinics in Liverpool, Manchester and London, with links for egg donation in Spain and Cyprus and when required Greece, USA, Mexico and South Africa, given links in the field of reproductive medicine over many years.

You should stop when you know you have tried your best and have nothing left to give. This is a difficult topic but one that are staff are used to having and are not afraid to be upfront and honest with you. Sometimes options that you have not considered come up.

Automation of the fertility process is coming soon. This can mean speedier work up, consistent decision making, using artificial intelligence and deep machine learning to help choose the best eggs, sperm and embryos. Automation of the ICSI process (sperm injection). Robotic cryopreservation (freezing). These advances should make treatment more accessible and decrease costs, whilst making the process more efficient. See www.ivf20.ai for more information. Work is underway for a ‘lab in a box’ for freezing eggs (Spain) and ‘lab in a van’ (USA), where the clinical team comes to you. Home ultrasound for cycle monitoring will come soon. It has been stated that artificial eggs from somatic (skin or cheek) cells could be available in the next 10 years. How that affects the significant impact on female age remains to be seen. There is a lot going on!