Patient treatment pathway
Here is an example of a general patient pathway but each treatment is as individual as you are and your treatment may require slightly different steps - CLICK each area for an explanation. Although we've successfully taken thousands of couples through this process, it can still be pretty stressful, so we ensure that guidance and counselling are available to you every step of the way.
STEP 1 Getting Started
Getting Started: We appreciate that being concerned about fertility can be worrying. As dedicated fertility specialists we see patients from all walks of life with differing problems - those who seek our advice because they have only recently become concerned about their fertility, and those who have had treatments elsewhere and need a fresh view.
Information: If you need further information or support at any time, we are happy to help. Please feel free to or more specific information packs from any of our CARE centres (contact us).
Additionally we hold regular information evenings in Nottingham, Manchester, Northampton and Sheffield where you can meet the staff, have a look round the unit and ask questions.
STEP 2 Consultation
Please feel free to call any of our centres to discuss how we can help. Some centres prefer a referral letter from your doctor that will provide us with all your relevant medical history. Once we receive this referral we will contact you to agree an appointment. Some local units might be happy to see patients in the first instance, without a referral letter.
As you'd expect, we'll discuss your medical and surgical history and talk about relevant options that are available to you. If you need further tests or examination, we'll try to perform it there and then. We want to minimise your journey and waiting time and will not request unnecessary tests and will use any up to date information you have. Arrangements will be made to check a semen sample because this helps to form an early view of the appropriate course of treatment. All of these aspects will be taken into account to personalize your treatment.
STEP 3 Ovarian Stimulation
To help improve the likelihood of success, drugs are used to stimulate your ovaries, this increases the number of eggs you produce.
We have many different regimes so that we can tailor therapy to your specific needs. In general, the stimulation drugs are administered daily, by injection. Training will be provided by our staff on how to carry this out.
STEP 4 Support and Monitoring
During the days leading up to egg collection your progress is monitored regularly and closely throughout this stage of your treatment. When tests show that your eggs are ready, there will be another injection to help the eggs mature before collection. The timing of this final injection is important.
Approximately 36 hours later your eggs are ready for collection and the clinic will give you the precise time to attend for egg collection.
STEP 5 Egg and Sperm Collection
Your eggs are recovered using a vaginal ultrasound procedure. This is a straightforward process that takes about 30 minutes, under sedation or anaesthesia and is considered an out-patient procedure. You should be able to go home within a couple of hours. The number of eggs collected varies between patients.
Once collected the eggs are prepared for the next stage by the embryologist.
Collection of Sperm: Your partner is usually requested to produce the sperm sample around the time of egg collection. Some patients may have sperm frozen whilst others might require a surgical sperm recovery, either under sedation or anaesthesia.
STEP 6 Egg Insemination
The prepared eggs are inseminated on the same day. This can be done in two ways:
IVF, where the eggs are mixed with a specially prepared sperm concentration, then moved to an incubator to fertilise;
ICSI (Intra-Cytoplasmic Sperm Injection), this highly skilled procedure involves a single prepared sperm being injected directly into the centre of an egg. The inseminated eggs are moved to an incubator to fertilise.
STEP 7 Fertilisation and Embryo Development
Fertilisation: Fertilisation occurs when a sperm fuses with an egg, this is checked the day after insemination (Day 1). Successful fertilisation is indicated by the fertilized egg (zygote) having 2 'pro-nuclei' (i.e. it contains two nuclei, one containing the maternal DNA while the other contains the paternal DNA) Zygotes at this stage are known as '2 PN´s'. Once observed the 2 PN´s are returned to the incubator for further monitoring.
Cleavage: Once the zygote divides into two cells (by the day following fertilisation) embryo development begins. Cleavage is the usual term used to describe the division of cells within the embryo (because for the first five days although the embryo increases in cell number it does not change its mass, but the cells, which get smaller and smaller, are 'cleaved' from the original egg mass). Each cell of the embryo has its own developmental programme, so that the embryo might have 2, 3, 4, 5 or 6 cells on the day after fertilisation (Day 2). Therefore, the number of cells on Day 2 is not critical to establishing a viable pregnancy. The quality of these embryos is assessed and graded from 1 to 4 (1 being the highest grade and only 1 or 2 being suitable for freezing). This is particularly important when considering the freezing of embryos.
STEP 8 Embryo Transfer
Embryos are transferred to the womb on either Day 2 or Day 3, or at the blastocyst stage ['blastocyst transfer'] on Day 5 or Day 6. Following PGD or PGS we almost always use blastocyst stage transfer. The embryo transfer procedure is straightforward and is almost always performed without the need for sedation or anaesthesia.
The HFEA only permits the transfer of two embryos except in exceptional circumstances. If three embryos are to be considered for transfer we will need to discuss this very carefully with you and document our reasons for the HFEA.
Soon after transfer a nurse will visit you and explain the next steps, but you will be able to go home soon after.
STEP 9 Pregnancy
Assessing the outcome of your treatment is performed in two ways, first the 'pregnancy test', which may need to be repeated, and the 'pregnancy scan'.
Pregnancy Test: This is usually taken 14-16 days after embryo transfer. The test results indicate whether or not an embryo has implanted in the womb. It might be very important to repeat this test and you will be given the necessary advice.
Pregnancy Scan: If the pregnancy test is positive an appointment will be booked for an ultrasound scan to see if a heartbeat is visible to show an ongoing pregnancy. Once this is confirmed you will then be discharged into the care of your GP who will arrange ante-natal care.
If the pregnancy test proves negative, a follow up appointment will be arranged to discuss your future options. Support counselling is, of course, always available.