Dr Rahnuma Kazem-Medical Director Care Fertility Northampton

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Dr Mohammed Khairy - Fertility Specialist - Birmingham

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Dr Nilkoletta Panagiotopoulou Consultant gynaecologist & subspecialist in Reproductive Medicine and Surgery

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Dr Alison Richardson

Infertility is defined by the World Health Organisation as the inability to conceive after a year of regular, unprotected sexual intercourse. However, this definition may vary slightly depending on factors such as age and medical history. Infertility isn't solely a female issue—both men and women can contribute to fertility challenges. Sometimes there is more than one contributing factor and sometimes, despite extensive investigations, no cause is found.&nbsp;&nbsp; Understanding the causes Female factorsOvulation disorders: Irregular or absent ovulation can make it difficult for women to conceive. Conditions such as polycystic ovary syndrome (PCOS) can disrupt ovulation patterns. Age: As women age, the number of eggs and their quality decreases. Uterine or fallopian tube issues: Structural problems within the reproductive organs, such as blocked fallopian tubes or uterine abnormalities, can make conception harder. Endometriosis: This condition occurs when the tissue lining the uterus grows outside of it, potentially causing inflammation and scarring that affects fertility. Male factorsLow sperm count or poor sperm quality: Issues such as low sperm count, abnormal sperm morphology, or reduced sperm motility can impact male fertility.Varicocele: A varicose vein in the testicles can lead to overheating, which may affect sperm production.Ejaculation disorders: Problems with ejaculation, such as premature ejaculation or retrograde ejaculation (where semen enters the bladder instead of exiting through the penis), can interfere with fertility.Genetic factors: Certain genetic conditions can affect sperm production or function, leading to infertility. Shared factors: Lifestyle factors: Habits such as smoking, excessive alcohol consumption, drug use, and poor diet can all negatively impact fertility in both men and women.Weight: Being overweight or underweight can disrupt hormone levels and affect fertility.Chronic Illness: Conditions such as diabetes, autoimmune disorders, and cancer can impact fertility through various mechanisms.Previous medical history: Previous infections such as mumps or prior surgeries&nbsp;Environmental factors: Exposure to toxins, pollutants, or radiation can affect reproductive health. Seeking help and treatmentFor couples struggling with infertility, seeking help from a healthcare professional is crucial. Fertility specialists can conduct thorough evaluations to try to identify the underlying cause(s) of infertility and recommend the best course of treatments. These treatments may include lifestyle changes, medications to stimulate ovulation or improve sperm quality, surgical interventions to correct anatomical issues, or assisted reproductive technologies (ART) such as in vitro fertilization (IVF). The emotional impact Infertility can take a significant toll on individuals and couples, both physically and psychologically. The journey to parenthood can be filled with disappointment and uncertainty, leading to feelings of stress, grief, and even depression. It's essential for those experiencing infertility to prioritise their mental well-being and seek support from loved ones, support groups, or mental health professionals. At Care Fertility, we provide counselling for those about to embark, or those going through treatment.Breaking the stigma Despite the prevalence of infertility, it remains a topic that is often associated with guilt and shame. Breaking the stigma surrounding infertility is crucial in creating a supportive environment where individuals and couples feel comfortable seeking help and sharing their experiences.&nbsp;&nbsp; Remember, you are not alone, and your experiences matter. At Care Fertility, our dedicated team of fertility specialists deeply understand the complexities and challenges of infertility, and we are here to offer unwavering support to individuals and couples on their journey to parenthood.&nbsp; With over two decades of experience, our experts provide compassionate care and treatment plans tailored to each person's unique needs and circumstances. Beyond medical interventions, ourholistic approach includes emotional support, counselling services, and access to support groups, ensuring that our patients feel empowered and supported every step of the way.<a href="/contact-us/" target="_self">Book a consultation now</a>

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Understanding infertility 
Infertility is a complex and multifaceted issue that affects millions of people worldwide. In the UK alone, approximately one in seven couples struggle with fertility issues. It's important to recognise that infertility does not discriminate – it can impact individuals of all ages, backgrounds, and lifestyles. 

Prof Alison Campbell is Chief Scientific Officer

Alison Campbell 

What is ICSI?ICSI is a specialised form of in vitro fertilisation (IVF) that was developed, over 30 years ago, to overcome male infertility factors. Unlike conventional IVF, where sperm and egg are combined in a petri dish to aid fertilisation, ICSI involves the direct injection of a single sperm into the egg using a microscopic needle, which is ten times finer than a human hair. We use micromanipulators and high magnification microscopes to perform ICSI. This technique helps fertilisation, even in cases of severe male factor infertility such as low sperm count, poor sperm motility, or abnormal sperm morphology. &nbsp;The <a href="https://youtu.be/ZDYrAdjmhUc" target="_self">ICSI procedure</a>:<ol><li>Ovarian stimulation: A woman / assigned female at birth (AFAB) partner undergoes ovarian stimulation to produce multiple eggs for retrieval, like the initial step in traditional IVF.&nbsp;</li><li>Egg retrieval: Once the eggs are mature, they are retrieved from the ovaries through ultrasound-guided aspiration.&nbsp;</li><li>Sperm collection: Simultaneously, the sperm sample, from the man/ assigned male at birth (AMAB) partner, or donor is prepared in the laboratory to isolate the healthiest and most viable sperm.&nbsp;</li><li>Microinjection: Utilising a specialised micromanipulation technique, one single sperm is directly injected into each mature egg by an expert embryologist.&nbsp;</li><li>Fertilisation and embryo culture: Following microinjection, the fertilised eggs (embryos) undergo close monitoring as they develop in the laboratory for several days.&nbsp;</li><li>Embryo transfer: We can perform a fresh or frozen-thawed embryo transfer. For a fresh transfer, the most viable embryo is selected for transfer into the uterus, typically 4-6 days after fertilisation (at the blastocyst stage), with the aim of achieving a successful pregnancy. Suitable embryos may be frozen (cryopreserved)<del>,</del> and thawed for transfer at a later date. &nbsp;</li></ol>Benefits of ICSI in IVF:<ul><li>Overcoming male factor infertility: ICSI helps individuals and couples going through male infertility issues that would otherwise prevent natural fertilisation.</li><li>Increased fertilisation rates: ICSI results average around 75% of eggs being fertilised. While this doesn’t guarantee conception, it is a slightly higher rate of fertilisation compared to IVF because we place the sperm into the egg rather than it having to make its own way.</li></ul>Is ICSI right for you? While ICSI offers hope to many who are struggling with fertility, it's important to speak with a fertility specialist to find out if its right for your specific circumstances. Factors such as the cause of infertility, previous fertility treatments, and overall health will influence the decision. <a href="https://www.carefertility.com/treatments-services/fertility-treatments/icsi/">Find out more about ICSI at Care Fertility here.</a> At Care Fertility, our experienced team of fertility specialists are committed to providing personalised care and guidance throughout your fertility journey. <a href="https://www.careweb-dev.salveemr.com/contact-us/">Contact us</a> today to schedule a consultation.&nbsp;

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If you are having trouble conceiving, you have probably researched a range of treatments that could help your dream of a family to become a reality. In what can feel like a minefield of information, we’re here to help.  

Whether you have read about Intracytoplasmic Sperm Injection (ICSI) before, or if this is your first time learning about ICSI, this blog aims to help you to understand the process of ICSI and how it could help you.  

Understanding BMI and fertilityYour Body Mass Index (BMI) is a figure that indicates whether you're at a healthy weight for your height.To work out your BMI, you divide your weight (in kilograms) by your height (in meters) squared. BMI is mostly used by healthcare professionals to gauge if your weight is in a healthy range, or ifit's below or above this. For example, if you weigh 65kg and you’re 5 feet 4 inches (=1.63m) tall, your BMI is 24.9kg/m2.The BMI weight categories as determined by the World Health Organization (WHO) are: • below 18.5kg/m2: underweight• between 18.5 and 24.9kg/m2: healthy weight• between 25.0 and 29.9kg/m2: overweight• above 30.0kg/m2: obese BMI is by no means a perfect measure of someone’s health. It only measures someone’s weight anddoesn’t tell us anything about the differences between bone, fat and muscle. For example, very muscly people will often have a high BMI, but that doesn’t mean they are unhealthy.&nbsp;So, what has a person’s BMI got to do with their fertility? Research shows that if your BMI is too low or too high, it can make it tricky to get pregnant. Having a low BMI: If you have a low BMI (under 18.5kg/m2) it can make it harder to have a baby. Your body might not have enough fat to keep your hormones balanced, which for women can disrupt your periods and make it harder to get pregnant. &nbsp;You also need to make sure that you consume enough calories to nourish both yourself and your baby, once pregnancy is established.If you think this might be you, it's a good idea to talk to a doctor about how to get to a healthier weight.Having a higher BMI: On the other hand, if you're BMI is over 25-30kg/m2, it can also affect fertility and make it harder to get pregnant. Carrying more weight also disrupts hormones and cause problems with periods, ovulation, and sperm quality. &nbsp;If you are overweight, you may be around 16% less likely to get pregnant than someone with a healthy BMI and if you are obese, this increases to around 28%.Even just bringing down weight by 5-10% can make a big difference to fertility and chances of pregnancy.Things you can do to help:<ol><li>Talk to a doctor: If you're worried about your weight and how it might be affecting your chances of having a baby, talk to a doctor. Our fertility specialists can help you figure out a plan to get to a healthier weight and improve your chances of getting pregnant.</li><li>Eat well: Make sure you're eating lots of healthy foods like fruits, vegetables, lean meats, and whole grains. These foods help keep your body healthy and can make it easier to have a baby.</li><li>Get moving: Try to do some exercise every day, like walking, dancing, or playing sports. Aim for 150mins/week of which 90mins should be moderate-high intensity aerobic (60-90% max HR). Exercise can help you lose weight if required and helps your body stay strong.</li><li>Prioritise sleep: Sleep is often overlooked yet can have a significant impact on our bodies. Getting a bad night's sleep has now been found to make us make worse health decisions next day such as poorer food choices, increased hunger and calorie intake, and less physical activity. All of these can contribute to weight management and hormone issues. Aim for 8-9 hours of sleep a night and try to go to bed and wake up at roughly the right times.</li><li>Take care of yourself:Trying to have a baby can be stressful, so make sure you're taking care of yourself emotionally too.&nbsp;Cortisol (the stress hormone) and stress related behaviours are the two main factors that make maintaining a healthy weight when stressed harder.&nbsp;Talk to friends or family if you're feeling stressed or consider talking to a counsellor who can help you cope with any worries you might have.</li></ol>Trying to have a baby can be a long and tricky journey, but understanding how your weight affects your chances can help. By eating well, staying active, seeking appropriate medical advice, and taking care of yourself emotionally, you can improve your chances of having a baby and make the journey a little easier. So don’t lose hope – with a little help from Care Fertility, you can make your dream of having a baby come true!

Woman cooking a colourful and nutritious quinoa stir-fry with mixed vegetables and a drizzle of olive oil.

Healthy cooking

Trying for a baby is a big deal, and sometimes there might be things that are making it harder to conceive.  

One of those things is how much we weigh. Being over or under weight can reduce a person’s fertility and therefore their chances to get pregnant. This is true for both men and women. 

So, let's talk about how Body Mass Index (BMI) and having a baby are connected, and what we can do about it. 

What is endometriosis?&nbsp;Endometriosis is a chronic and progressive condition where tissue like the lining of the uterus (the endometrium) grows outside of the uterus, typically on the ovaries, fallopian tubes, and other pelvic organs. &nbsp;This tissue behaves exactly like the lining of the uterus, thickening, breaking down, and bleeding with each menstrual cycle. However, because it has no way to exit the body, it becomes trapped, leading to inflammation, pain, and the formation of scar tissue or adhesions.&nbsp;What are the symptoms on endometriosis?&nbsp;<ul><li>Extremely painful periods.</li><li>Pain during sex</li><li>&nbsp;Pain when passing urine or stools.&nbsp;</li><li>Vaginal bleeding when you're not on your period</li><li>&nbsp;Very heavy periods.&nbsp;</li><li>Difficulty conceiving</li></ul>Endometriosis can be hard to diagnose, and whilst periods can be painful for many, if you are experiencing any of the above it’s worth speaking to your doctor to find out more. &nbsp;How does endometriosis impact on fertility?&nbsp;The relationship between endometriosis and fertility is complex. The good news is, is that not everyone&nbsp;with endometriosis struggle to conceive, in fact, it’s estimated around 50-70% of people with endometriosis will have no issues at all. &nbsp;<ol><li>Physical changes: Endometriosis can cause adhesions and scar tissue, which may change the pelvic anatomy, making it difficult for eggs to travel from the ovaries to the fallopian tubes to meet the sperm trying to&nbsp;reach the egg.&nbsp;</li><li>Ovulation disruption: Endometriosis can interfere with ovulation, the release of an egg from the ovary. Eggs need to be released from the ovary before they can be fertilised, without ovulation there is no opportunity for an egg to be fertilised and for a pregnancy to start. &nbsp;</li><li>Inflammation: The chronic inflammation associated with endometriosis can have a big impact on egg quality, implantation, and the overall environment&nbsp;needed for a healthy pregnancy.&nbsp;</li><li>Altered immune response: Endometriosis can affect the immune system, potentially creating a womb that might not allow&nbsp;embryo implantation (when the fertilised egg attaches to the uterus lining)&nbsp;to occur. In short, the immune system will reject the embryo. &nbsp;</li></ol>If you are trying to conceive and have either have an endometriosis diagnosis or think you might have it, there are a variety of things you can do to help you on your journey to becoming a parent. &nbsp; How can I improve my chances of falling pregnant with endometriosis?&nbsp;While there's no guaranteed way to overcome endometriosis-related infertility, there are steps you can take to help improve your chances of conceiving:&nbsp;<ol><li>Healthy lifestyle changes: Focusing on maintaining a healthy weight, eating a balanced diet rich in fruits, vegetables, and whole grains, and engaging in regular exercise such as going for a walk or doing some online yoga classes. Cutting back on things like smoking and alcohol are also important steps to supporting fertility.&nbsp;</li><li>Avoiding stress: This might feel almost impossible but managing stress is essential for fertility. Cortisol, the stress hormone has an important role to play in keeping us safe but when we have high levels of it all the time, it can be harmful to the body. Where possible try to limit stressful things in your life and give simple breathing techniques or things like meditation, or mindfulness a go.&nbsp;</li><li>Speak to a professional: Consult with a <a href="https://www.carefertility.com/teams/">fertility specialist</a> who has experience in treating endometriosis-related fertility issues. They can provide tailored advice and treatment options based on you.&nbsp;</li><li>Find out more: By learning more about <a href="https://www.carefertility.com/blog/endometriosis-and-fertility/">endometriosis</a>, its impact on fertility, and <a href="https://www.carefertility.com/treatments-services/fertility-treatments/ivf/how-does-ivf-work/">available treatment options</a>, you will&nbsp;empower yourself to make informed decisions about your fertility options – this will help you&nbsp;to advocate for yourself and your body. &nbsp;</li></ol>What fertility support is available at Care Fertility for those with endometriosis?&nbsp;At Care Fertility, we’ve been treating people trying to conceive with endometriosis for over 30 years.&nbsp; We understand the challenge that it presents, and we have helped thousands of women become parents despite endometriosis. If medical management of your endometriosis isn’t working, and you’ve had difficulties getting pregnant, your doctor may suggest in vitro fertilisation (IVF).&nbsp;Some of the fertility support options available include:&nbsp;<ol><li>Fertility assessments: Our team of fertility specialists provide&nbsp;comprehensive evaluations to assess ovarian reserve, pelvic anatomy, and other factors influencing fertility – this will help you to understand your chances of getting pregnant naturally, and what help is needed to improve your chances of success.&nbsp;</li><li>Assisted Reproductive Technologies (ART): Advanced reproductive techniques such as IVF may be recommended for individuals with endometriosis-related infertility. If you decide that IVF is right for you, our dedicated team of fertility specialists will create a personalised treatment plan that is tailored to your needs.&nbsp;</li></ol>Navigating fertility challenges associated with endometriosis can be daunting, but it’s important to remember that you are not alone. With the right support, knowledge, and by taking proactive steps, many women with endometriosis go on to have healthy pregnancies. At Care Fertility, we're here to support you every step of the way on your journey to parenthood.&nbsp;<a href="https://www.carefertility.com/contact-us/" target="_self">Book a consultation</a>

Endometriosis blog header

Endometriosis is a condition that affects millions of women worldwide, it’s estimated that one in 10 women suffer from it.  

Despite endometriosis being a common condition among women, it remains widely misunderstood, especially regarding its impact on fertility. If you're grappling with endometriosis and hoping to conceive, it's important to understand what’s going on and explore available support options. 

What is egg freezing?&nbsp;Egg freezing, also known as oocyte cryopreservation, is a process where a woman's eggs are collected, frozen, and stored for future use. It offers people the opportunity to preserve their fertility for various reasons, such as career goals, medical treatments, or personal circumstances.&nbsp;Who can freeze their eggs?&nbsp;Women who haven’t gone through the menopause can freeze their eggs. To increase the chances of a successful pregnancy from using a frozen egg, the best time to freeze eggs is in your 20s and early 30s.&nbsp;&nbsp;Age is a crucial factor since egg quality declines with age, making younger women more likely to have viable eggs for freezing. A lower BMI is often associated with better reproductive health and may indicate a lower risk of complications during the egg retrieval process. Additionally, having good quality eggs is essential for successful freezing and later use in fertility treatments.&nbsp;Typically, those who are below the age of 30, have a Body Mass Index (BMI) less than 35, and possess good quality eggs are the most suitable candidates for egg freezing.&nbsp;Understanding the process:&nbsp;The egg freezing process typically involves several stages, that happen in a 2–3-week timeframe:&nbsp;<ol><li>Ovarian stimulation: You'll undergo hormonal injections to stimulate your ovaries to produce multiple eggs.</li><li>&nbsp;Egg retrieval: Once your eggs reach maturity (meaning they have developed from a follicle into an egg that can be fertilised), they're retrieved via a minor surgical procedure under sedation, and the quality of the eggs is assessed using our <a href="https://www.carefertility.com/donation/ivf-using-donor-sperm/">Artificial Intelligence</a> <a href="https://www.carefertility.com/donation/ivf-using-donor-sperm/">EggSafe</a><a href="https://www.carefertility.com/donation/ivf-using-donor-sperm/">-AI.</a></li><li>Freezing: Once the eggs have been assessed, they are then frozen using a technique called vitrification, preserving them at sub-zero temperatures.</li><li>Storage: The frozen eggs are stored in a fertility clinic's laboratory until you decide to use them. Storage is an ongoing cost of egg freezing, paid either annually or monthly. More information on costs can be found <a href="https://www.carefertility.com/treatments-services/fertility-preservation/egg-freezing-storage/">here.</a></li></ol>How many times do I need to freeze my eggs?&nbsp;The number of times someone has to go through the egg freezing process will depend on how many mature eggs are collected.&nbsp;The estimated number of mature eggs required to give a high and realistic chance of success at a later date is 15-20 mature eggs. If less than 15 eggs are collected, it will be recommended that patients go through another round. &nbsp;Addressing concerns:&nbsp;1. Success rates: According to the Human Fertilisation and Embryology Authority (HFEA), success rates for egg freezing vary depending on factors such as age and the number of eggs frozen. For women under 35, the chance of a live birth from thawed eggs is around 18-30%. The success rate is often lower than that of IVF from a fresh egg, mostly related to the age, as women using a thawed egg will often be over the age of 35.&nbsp;&nbsp;2. Risks: While egg freezing is generally safe, as with any medical procedure, there are potential risks. These include <a href="https://www.carefertility.com/support/ivf-resource-hub/glossary/">Ovarian Hyperstimulation Syndrome (OHSS),</a> which occurs in a small percentage of cases, as well as the possibility of no eggs being retrieved.&nbsp;3. Emotional considerations: Deciding to freeze your eggs can evoke a range of emotions, from hope and empowerment to anxiety and uncertainty. It's essential to seek support from loved ones and consider counselling, which we provide, if needed to navigate this emotional journey.&nbsp;Is egg freezing right for you?&nbsp;Ultimately, the decision to freeze your eggs is deeply personal and should be based on your individual circumstances, goals, and values. It's advisable to consult with a fertility specialist who can provide personalised guidance based on your medical history and preferences.&nbsp;Egg freezing offers cisgender women, transgender, and non-binary individuals the opportunity to take control of their reproductive futures, providing a sense of security and peace of mind. By understanding the process, risks, and potential outcomes, you can make an informed decision that aligns with your fertility goals. Remember, you're not alone on this journey – we are here to guide you every step of the way.&nbsp;If you're considering egg freezing, don't hesitate to reach out to our team for more information and support. Your future fertility is worth investing in, and egg freezing may be the right choice to preserve your options for the years ahead.&nbsp;For more information about how much it costs, head to <a href="https://www.carefertility.com/treatments-services/fertility-preservation/egg-freezing-storage/" target="_self">egg freezing and storage page.&nbsp;</a><a href="https://www.carefertility.com/contact-us/" target="_self">Book a consultation</a>

Egg donation/egg freezing

Thinking about freezing your eggs can be both empowering and overwhelming. It's a significant decision, and you likely have a multitude of questions and concerns swirling in your mind. Whether you're considering egg freezing for personal or medical reasons, understanding the process, risks, and success rates is crucial. In this blog, we'll delve into the world of egg freezing and address the most common concerns. 

Charlotte Swami

International Women’s Day is a poignant reminder of the strength, resilience, and invaluable contributions of women across the globe. &nbsp;We spoke with <a href="/profile/charlotte-swami/?team=Leadership" target="_self">Charlotte Swami</a>, and asked her what International Women’s Day means to her, and here’s what she had to say:&nbsp;What does International Women’s Day mean to you as a female leader at Care Fertility?&nbsp;&nbsp;Strong women. May we know them. May we be them. May we raise them. As a midwife, executive director of Care Fertility, global advisor, honorary lecturer, wife and mother of three young children, I am reminded each day of the importance the critical role that women play in society and our homes. I am blessed by so many colleagues who exemplify this and strive to support our patients through their fertility journey with compassion; our nurses, midwives, and allied health professionals are the most incredible team of individuals.&nbsp;&nbsp;&nbsp;I have supported women through my career as service users, but I am also passionate about mentoring students and team members to raise them in their career to achieve their maximum potential, and to develop our future leaders. I have the most exceptional team of nursing and clinical professional leaders at each clinic, who I am honoured to work with. To my own daughter’s I teach them daily on the importance of having their own future professional career, and the autonomy and independence that comes with this.&nbsp;What sets Care Fertility apart from other fertility clinics?&nbsp;&nbsp;Our team of midwives, nurses, counsellors, and allied health professionals set us apart. They play a crucial role in delivering our patient pathways, both in clinics and in our central donation team. We're invested in our teams, developing career frameworks to support our experts in their professional journey, providing them with constant learning opportunities to grow in their roles.&nbsp;How do you ensure inclusivity and personalised care for each patient at Care Fertility?&nbsp;&nbsp;We are a team that reflects the society that we serve, and we are passionate about providing holistic and personalised care to our service users. Family is important for everyone, and we work hard to ensure that we support our clients at every step of that emotional journey to maximise their chance of success.&nbsp;&nbsp;What was moment where you felt you had made a positive impact?&nbsp;&nbsp;On a personal level I had provided preconceptual advice to a family friend, last year including referral to a colleague, and out of the blue this morning I received a 12-week scan image. That was truly magical, and reminded me what an amazing field we are involved in. Having personal experience of infertility, I appreciate the rollercoaster of emotions that individuals go through on this journey, and when we witness life changing success, it is just incredible. &nbsp;On a professional level, when I see our community of nurse leaders collaborating to provide the best patient experience on a weekly basis and supporting one another to grow the skills and knowledge within our team.&nbsp; As well as hearing individual team member’s success from our training courses, I love to see people succeeding.&nbsp;&nbsp;How does Care Fertility create a welcoming and supportive environment for new patients, especially those navigating fertility for the first time?&nbsp;&nbsp;Our team have a deep understanding of what our clients have trusted us to support them with, and how emotional a journey that can be. Our many years of combined experience, and expertise focus on ensuring that we listen to patient feedback to ensure that our service continually evolves to provide the best care possible.&nbsp;As we celebrate International Women’s Day, we are reminded of our commitment to inclusivity, personalised care, and unwavering support for every individual embarking on the journey of fertility. Through collective effort, empathy, and a shared vision, we continue to pave the way for a future where women not only thrive but also uplift one another. Together, let us honour the journey, celebrate the successes, and champion the resilience of women everywhere, today and every day.&nbsp;

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As a female leader within Care Fertility, Clinical Director Charlotte Swami has found that her role intertwines with various facets of her life - from being a midwife, executive director, global advisor, to a wife and mother – and she is deeply touched by the significance of this day. 

We are delighted that at Care we can enhance our embryo grading using <a href="https://www.carefertility.com/treatments-services/embryology-treatments/caremapsai">Caremaps-AI®;</a> a clever, new technology that also grades your embryos based on their development throughout their week of culture, and not just their appearance. This ultimately enables us to better select the embryo that is going to give you the best chance of having a baby. This blog describes how we grade and select your embryos in the lab and the benefits of having Caremaps-AI® on your treatment plan.Care’s morphological embryo grading system5 days after your egg collection the embryo should have reached the <a href="https://www.carefertility.com/treatments-services/embryology-treatments/blastocyst-transfer">blastocyst stage</a>, at which point it will have around 150 cells and will be filled with fluid. A blastocyst is considered the strongest stage of an embryo, it is the highest potential that we are able to observe in the laboratory that the embryo is capable of forming a pregnancy. At this point, we can grade the embryo on its appearance. This is known as a morphological grade. We look at:<ul><li>the expansion status of the embryo – i.e. how ‘big’ the blastocyst is - this can vary from a very early blastocyst (VEB), early blastocyst (EB), full blastocyst (FB), expanded blastocyst (ExB), hatching blastocyst (HB), or fully hatched blastocyst (FHB)</li><li>the inner cell mass of the embryo (the part that forms the baby)</li><li>and the trophectoderm of the embryo (the part that forms the placenta)</li></ul><img src="https://eu-images.contentstack.com/v3/assets/blt5849df6ac36913cd/blte414285818777014/65a6a22b907405040aaab65b/image.png" height="auto"/>We classify anything with grades 1 or 2 as good quality (and suitable for freezing), and anything with grade 3 as borderline/poor quality. Embryos with either the inner cell mass or trophectoderm graded as a 3 can be frozen if we consider them to be borderline, and the other cell type is good quality, but the survival rate of these embryos may not be as high as a good quality embryo. We don’t freeze anything that scores a 3 for both cell types.Without time-lapseWhen embryos are cultured in standard incubators, they are left undisturbed for their 5 days of culture (except for when checking them for fertilisation). In order to assess the grade of each embryo on day 5, we have to remove your dish from the incubator and have a very quick look under the microscope at each embryo. This means that we only have a brief snapshot of how the embryo looks before we make the decision about whether to transfer, freeze, or discard each embryo.With time-lapse and Caremaps-AI®If your embryos are cultured in our time-lapse incubator, this means that photos are automatically taken of your embryos every ten minutes throughout the 5 days of culture. This gives us a time-lapse video of your developing embryos to analyse, and therefore much more information than just the embryo’s morphological grade (as described above). For example, we can see how long the embryo took to reach 2 cells, 4 cells, 8 cells, and so on. We can then use AI software to analyse this information and apply a specific morphokinetic algorithm (known as Caremaps), which scores embryos on their live birth potential from 1-10 (with 10 being the best) based on how closely they hit the right milestones at the right timepoints. It is very normal for embryos to look identical, but have very different Caremaps scores.For example, we may have three embryos that have the exact same morphological grade and we cannot easily distinguish between them on eyesight alone. However, we find they have Caremaps scores of 2, 6, and 10. We know from our extensive research that:<ul><li>Caremaps score 2 has a 7.4% chance of live birth.</li><li>Caremaps score 6 has a 26.2% chance.</li><li>Caremaps score 10 has a 45.9%.</li></ul>&nbsp;Therefore without the algorithm, we may inadvertently choose an embryo for transfer that has a lower live birth potential than a second available embryo. Of course, this second embryo could be frozen for future use, but our goal is for you to take home a baby as soon as possible and therefore we want to be sure we are choosing the embryo with the highest potential in the first instance.Using Artificial IntelligenceOnce the embryos have been given a morphological grade, the Caremaps algorithm is run on all blastocysts that are deemed suitable for transfer or freezing. The algorithm actually takes into account the final morphological grade, along with the developmental time points mentioned previously. To select the embryo to transfer, we always choose the embryo with the highest Caremaps score. This <a href="https://nationaltechnologyawards.co.uk/winners23.php">award-winning</a> algorithm has been created specifically for Care patients and is based on over 6000 embryos. The algorithm is regularly validated against our latest results, ensuring when your embryo is analysed, it is done so by the most up to date technology.Until recently, studying and annotating the developmental timepoints of embryos in order to generate a Caremaps score was a task completed by the embryologist. Although our embryologists are all very well-trained in studying embryos, we are human and some developmental timepoints have always been relatively subjective. We are really pleased therefore to introduce new artificial intelligence software, Caremaps-AI®, which looks at the development of your embryos automatically – it is very robust and was trained on nearly half a billion photographs of embryos! Using AI means that every embryo is annotated consistently, which makes us even more confident in grading embryos with Caremaps. Furthermore, marking every time-point for each stage of development for each embryo was a very time-consuming process for embryologists. This time can now be used to focus on other important lab processes and of course be on hand to answer any questions you might have.Implantation rates and Caremaps-AI®Caremaps-AI® is the most advanced piece of equipment we have in the laboratory to select the best embryo for you- the embryo that will give you the best chance of having a live birth. Although our system is very clever, the scores are still just a prediction. There is still the chance of having a high-quality embryo transferred, with a high Caremaps score, and it sadly still fails to implant. It is very hard for us to understand why this happens. The doctors will do everything to prepare your uterus lining for transfer and the embryologists will do their very best to create and select the best embryos they can for you.However, there are crucial interactions between the uterus and the embryos that need to occur in the days after the transfer, which we are not able to control or visualise. Studies are ongoing in this area - they are understandably very hard to undertake - but we are hopeful that in the future we will be able to gain a greater understanding into why some embryo transfers are not successful. Another reason may be that some high-grade embryos fail to implant because they are genetically abnormal. The chance of genetic abnormalities occurring in an embryo does usually increase with the age of the egg provider, therefore <a href="https://www.carefertility.com/treatments-services/reproductive-genetic-testing/pgt-a">genetic testing</a> may be recommended to you if deemed appropriate by your doctor.Please rest assured that lower grade embryos can still be transferred, as they still have a chance of resulting in a live birth. We would not transfer embryos we did not think had a chance of implanting. If an embryo has a lower Caremaps score, as you might assume, it does mean it has a lower chance of resulting in a live birth, but it does not mean there is no chance at all.How much is Caremaps-AI®?Caremaps-AI® costs £995 on top of your treatment costs and is available to everyone. However, using Caremaps means that, as the best embryo is selected for you initially, it may reduce your chance of having to return for repeat cycles in the future.

four embryos

As has been done for decades in the field of IVF, we grade each and every embryo in the lab by its appearance (known as the morphological grade). 

What do we know about donor ethnicity and availability from UK statistics? <div type="entry" class="embedded-entry redactor-component block-entry" data-sys-entry-uid="blt1d81766b1cf126ba" data-sys-entry-locale="en-gb" data-sys-content-type-uid="quote" sys-style-type="block"></div> A preliminary HFEA Report on ethnic diversity in fertility treatment, published last month, described the import of donor sperm from outside of the UK as an increasingly common trend for patients. A key reason for this is likely for ethnicity matching. Ethnicity and donor sperm The report indicated poor availability of diversity in sperm donors in the UK. Although around half of all treatments using donor sperm were imported from abroad, almost three quarters of donor sperm with ethnicity registered as Mixed, 60% of Black ethnicity and 38% Asian, were imported. What about donor eggs? The same report shows that donor eggs used in this period were mostly from the UK but higher proportions of Asian, Black and Other ethnicities were imported, than for White or Mixed ethnicity donors.Why is there a lack of ethnic diversity in egg and sperm donors? It is not entirely clear why this is the case but it may be due to attitudes, social or religious factors, lack of awareness of the process or the demand.Some good news! Care Fertility can currently offer recipients choice of mixed heritage eggs from White &amp; Black Caribbean and White and Black African donors. With inclusivity and choice in mind, we always endeavour to recruit donors with a broad range of ethnicities. We also have donor sperm availability in our own bank with the following ethnicities: White &amp; Black African, Indian, Chinese and Black African, as well as Other Mixed Background. Where we don’t have specific ethnicities, we endeavour to help patients source suitable donors.If you are in need of donor eggs or sperm, or wish to help someone looking for a suitable donor, please get in touch….

Things to consider thumbnail

We know how important it is to be able to offer ethnic diversity and choice to our patients. This is a key reason why we have our own donor egg and sperm banks at Care Fertility.

We gained 10 eggs, 4 made it to <a href="/treatments-services/embryology-treatments/blastocyst-transfer" target="_self">blastocysts</a>. After collection I was really unwell &amp; OHSS was queried. I ended up in hospital on the day of transfer. The transfer was cancelled. This was soul destroying but on reflection was the best decision for us. I made a full recovery &amp; 2 months later we transferred our first embryo. On test day, I couldn’t believe my eyes, we had a positive. However, a few days later I had a big bleed with lots of pain. I spoke with the clinic who were very supportive over the telephone who said to rest. The next morning I was beside myself &amp; I asked for a hcg blood test, this came back on the Friday at close to 4000, I had a repeat blood test 2/3 days later &amp; this had reduced to 700 which I was told by the nurses was a chemical pregnancy. I hated this term. As I did gain a positive test &amp; to us as a couple it was a loss of a chance. 3 weeks later I did another pregnancy test &amp; I found the test was really dark, I went to the clinic for a repeat hcg &amp; it had risen to 600, I had a scan &amp; there was a shadow on my left side. I was referred to the early pregnancy unit. After a few weeks &amp; every other day hcgs at epau I was diagnosed with an ectopic pregnancy &amp; I had to decide on methotrexate or having surgery to remove my Fallopian tube. I decided on methotrexate. Emotionally the ectopic pregnancy took a huge toll on me &amp; I think it being our first <a href="/treatments-services/fertility-treatments/ivf" target="_self">IVF</a> chance it did break us down as a couple. This was October 2020. April 2021 I had another embryo transferred &amp; I asked for my progesterone checking as I felt it may have been low as I bled early in October. On transfer day my progesterone was found to be very low, therefore, I was given triple progesterone. On test day again, I tested positive, we were more wary this time &amp; aware of what we could lose. Just before 5 weeks again I had bleeding &amp; my hcg this time did decrease normally. After our second loss, we wanted more tests, I was already having weekly acupuncture &amp; the lady I used at life &amp; lemons was fantastic &amp; talked me through tests that may uncover health issues. I had clotting bloods taken &amp; nk cell testing. My clotting bloods showed I had immune issues requiring steroids &amp; clotting issues which meant I needed blood thinning injections for the whole of pregnancy, alongside aspirin. We had to have the bloods repeated after 3 months which showed I maybe did not require blood thinners, therefore it wasn’t added to my October 2021 protocol. October 2021, I decided to not use steroids, to use aspirin &amp; to see how the next transfer went. Again I gained a positive test, but again I bled after test day. My hcg declined as normal. I feel because of the heartbreak &amp; the fear of having another ectopic pregnancy, losing again &amp; it being straightforward didn’t cause as much mental scarring. We enjoyed Christmas together &amp; planned to go again in January 2022. January 2022, we transferred the last embryo from our first collection, I used aspirin &amp; steroids this time around. This cycle I didn’t gain a positive at all. I felt like this was it for us, we had used our nhs round &amp; I wasn’t sure if we would ever be parents. I felt the world was against us &amp; it just wasn’t meant to be. We decided to live a little &amp; we booked a holiday to Mauritius, a zika free country just incase we conceived naturally. Whilst we were on holiday we discussed doing another <a href="/treatments-services/fertility-treatments/ivf" target="_self">IVF</a> round &amp; whilst away I contacted the clinic. On landing in the UK we paid for a multi cycle with the clinic. I wanted the clotting bloods again as I felt I had a positive for lupus anticoagulant &amp; it had shown as negative on the second set of bloods 3 months after. The 3rd bloods showed I did have lupus. Which meant I needed blood thinners throughout the whole pregnancy if successful. March 2022 I had our 2nd egg collection. I gained 9 eggs, 5 made it to blastocysts. This time I was well &amp; I was able to have a transfer. Just before test day I began to bleed again, I did an early test &amp; this came back as positive. I contacted the clinic &amp; had a hcg. This came back as 311, 2 days later it was 728. Our consultant upped my progesterone &amp; I was placed on bed rest. I had really painful period cramps &amp; I thought I was definitely out again. At 6 weeks I had a scan, this was early to ensure the pregnancy was in the right place &amp; not ectopic again. It was confirmed the pregnancy was in the correct place but there was no heartbeat so I was asked to return 11 days later. At this point I began bloating &amp; at work I was asked if I was pregnant by colleagues. At 7+4 we went for a scan &amp; unbelievably two little heartbeats were found. The feeling was unreal, it was so exciting but also worrying at the same time. We had identical twins inside me. The pregnancy was really difficult, I had hyperemesis, gestational diabetes, I had to walk with crutches due to spd, low haemoglobin, placenta previa at one point. I was scanned every fortnight. There was a worry at one point of twin to twin transfusion but this settled. At 33 weeks I had reduced movements from twin 1, I went to be monitored &amp; I was having tightenings which I’d had for a while but this time they were becoming more regular &amp; showing up on the ctg monitor. I had a vaginal swab &amp; it was found I was highly likely to go into premature labour within a week. I was admitted to the ward. At 33+5 weeks my waters went &amp; I was planned for a c-section.&nbsp; During the section I had low blood sugars &amp; required a blood transfusion. My baby girls were born at 3lb 8/9ozs. They were whisked off to the Neonatal ward where they stayed for 12 days. To get to where we are I’ve had to do 100s of injections, horrible painful procedures &amp; endured the worst heartbreak I didn’t feel I could have ever gotten through. But here I am with my two baby girls who are soon to be one year old, feeling incredibly lucky that my life has two beautiful baby girls in it. Twins in themselves have no health problems. I’ve found being a twin mum very difficult, my body endured a lot in pregnancy &amp; for this reason I would never advocate anyone having more than one embryo transferred. Being a twin parent really does push you to your limits &amp; I have little time for myself but I do have twice the moments/love &amp; double trouble. Dreams really do come true. We feel extremely lucky to be in this position in life. We do still have 4 remaining embryos which I don’t think we will use. <a href="/fertility-clinics/sheffield" target="_self">Care Sheffield</a> with <a href="/about-us/our-teams/dr-georgios-petsas" target="_self">Dr Petsas</a> made this happen &amp; I cannot thank them enough for giving us our little family.

Ashley and jason twin babies

We began IVF in 2020 after 3 years of trying to conceive. I have endometriosis. Covid had struck 6 months prior & treatments had been delayed which left us feeling sad & frustrated.
Finally we had our first appointment with Care Sheffield & within a month I had commenced treatment for egg collection. 
I found the process really stressful, we had lots of ups & downs emotionally. A lot of desperation & hope. I feel we always thought IVF would work the first time around, after all why wouldn’t it. 

In her own words, Claire's fallopian tubes were ‘knackered’ but thanks to the IVF process, which used her own eggs, Claire and her husband Jason, are now celebrating toddler Harrison-Jay’s fourth birthday.At the end of last year, Claire decided to go back to the clinic where she had her own treatment, but this time it was to <a href="https://www.carefertility.com/donation/donating-your-eggs/" target="_self">donate her eggs</a> and help others who were experiencing fertility issues. She said:‘We had IVF and I had been thinking about what I could do to help after having Harrison. I just wanted to give something back, I know there are women out there struggling.I felt a bit of failure at first when we went for IVF because my body wasn't working properly.Everyone has different reasons for having IVF. Some have had cancer and had their ovaries removed, or are gay and want to start a family.It is awful wanting a child and not being able to have one. I know that and I had Harrison. It feels good to help someone else.’Care Fertility teams have supported many people who need IVF with donor eggs over the last twenty-five years, and have a thorough selection process for all donors. Claire had to have an assessment and consultation – which includes talking to a counsellor about the ethical implications of donation. Egg donors are then carefully monitored by the fertility nurses, and have to administer daily injections for three to four weeks, to help produce more than one egg. In addition to the injections, there are regular ultrasounds and blood tests to check everything is working as it should.Donors and recipients are carefully matched for height, weight, hair and eye colour and blood group. Once a recipient is found the donor is put on the contraceptive pill until both women's menstrual cycles are synchronised. Eggs are collected with ultrasound guidance as a needle is carefully passed into the ovary where the eggs are found.The procedure only takes around 30 minutes and is carried out under sedation. Sperm is then introduced to the egg and the early embryo is incubated for five days before being transferred to the recipient mother.After undergoing IVF, the process was not daunting to Claire but she did have to overcome some hurdles.She explains: ‘I couldn't inject myself, I had to get my husband to do it for me!I was more nervous going through IVF. As the donor you don't have to find out how it goes afterwards but if you are the lady becoming pregnant, there's lots to worry about”I don't feel strange about donating, I’m not the parent. It is their child. I'm just glad if I have helped someone out.’Following the pregnancy, donors can find out if the treatment has been successful for the recipient, the year of the baby’s birth and their gender. Donors are also invited to write a letter of goodwill which can be given to the child when they turn 18 - if they are aware they were born through donation.After a change in UK law in 2005, the child can also find out the details of the donor when they turn 18.What are the criteria for becoming an egg donor?Donors must be under 35, as egg quality deteriorates after this time, and have no history of genetic conditions like haemophilia, Type 1 Diabetes, cystic fibrosis or conditions such as Down's syndrome in at least three generations of their family.They must also be within a healthy BMI and not smoke or drink excessively.Egg donors are compensated with £750 for their time.Helen Mitchinson, the nurse co-ordinator at Care Fertility Bolton, says the intensive process can lead some to drop out but hopes others can see it through.She added: ‘Donors go through a lot to help someone have a baby. I think the women who do it are very brave.’Philip Lowe, a Consultant at Care Fertility Manchester, thanked all previous donors from across the region for their generosity.He said: ‘Without them we simply couldn’t help many of our patients’ become parents. Donors and recipients can be reassured that we only recruit donors in the UK, giving them the protection of strict UK regulations and screening.All donors have specialist counselling and are health checked. We would love more donors to come forward - they are a wonderful group of men and women and they quite literally have the ability to change another woman’s life.’Care Fertility welcomes enquiries from sperm and egg donors who are willing to go through the process and help make a family. <a href="https://www.carefertility.com/donation/donating-your-eggs/" target="_self">Click here</a> for more information on egg donation, and how to apply.Quotes are extracted from the Lancs Telegraph.

Why I wanted to donate

When Claire held her little boy in her arms for the first time, it was the completion of a long journey. Having experienced her own fertility issues, Claire knew that she wanted to donate her eggs, and help others on their path to parenthood. 

Audrey Dearing Genetics Counsellor

Audrey Dearing

What is DNA?DNA stands for deoxyribonucleic acid and is the chemical that all forms of life on earth use as “instructions” about how to develop and function. It’s present in virtually every cell in your body and contains the genetic code which is unique to you.World DNA Day celebrates the date James Watson and Francis Crick published their research on the structure of the DNA molecule, on 25 April 1953. Their work paved the way for countless scientific discoveries which led to major advances in the diagnosis and treatment of diseases.The shape of DNA was shown to be a “double helix”, rather like a long, twisted ladder in which the rungs hold the genetic information. DNA molecules are very long and are coiled up very tightly into chromosomes.How&nbsp;does DNA relate to IVF treatment?Most cells in the body contain 46 chromosomes (23 pairs, one chromosome from each parent in each pair). Mature eggs and sperm each contain half that number – 23 single chromosomes – which come together during fertilisation to form an embryo with the 46 chromosomes necessary for normal development to a baby. If an embryo doesn’t have 46 chromosomes, or if the DNA within a chromosome is damaged, patients might find it more difficult to become pregnant or could be at higher risk of miscarriage. However, there are many things we can do to help identify any problems and create a treatment plan which will give you your best chance of having a healthy baby.When a sperm fertilises an egg, the resulting embryo should have 23 pairs of chromosomes, one of each pair from the egg and the sperm. If an embryo doesn’t have the right number of chromosomes, it results in a failure to implant, miscarriage or (rarely) a child with a serious genetic condition.How&nbsp;do&nbsp;I know if my embryo has the right number of chromosomes?Embryos with the wrong number of chromosomes are known as aneuploid. Any patient can be at risk of having aneuploid embryos. In fact, most have a mix of aneuploid and normal.The number of aneuploid embryos is known to increase as a woman gets older. Each month before ovulation, eggs go through a process of maturation, concluding with cell division (called meiosis). Older eggs are more prone to errors during this division process, which is why it’s more likely that older eggs will contain abnormal DNA. For women over 37, at least half of embryos are likely to be aneuploid, and the incidence increases to almost 80% by age 43.Embryos can be tested to see if they are aneuploid or not.&nbsp; This test is called PGT-A (<a href="https://www.carefertility.com/treatments-services/reproductive-genetic-testing/pgt-a">Pre-implantation Genetic Testing for Aneuploidy</a>). PGT-A works by analysing the amount of genetic material within embryos, checking how many chromosomes are present. In order to do this, a small number of cells are carefully removed (biopsied) from the outer layer of a blastocyst-stage embryo, and these cells are then sent to a specialist genetics laboratory for analysis. We would recommend that only chromosomally normal embryos are considered for replacement back into the womb, however all patients who choose PGT-A will have free appointments with our specialist fertility and genetics counsellors to help them decide on the treatment that is best for them.PGT-A could shorten the time from treatment to successful pregnancy as it prevents transfer of embryos that are aneuploid. Embryos with a normal number of chromosomes have lower miscarriage rates and higher live birth rates per embryo transfer.We can even do PGT-A testing on embryos that are already frozen. If you have frozen embryos and wish to know if they have the potential to lead to successful treatment, they can be thawed, biopsied for PGT-A, and then re-frozen. 98% of embryos survive thaw at Care, and if a patient has embryos elsewhere, we can transport them to one of our clinics for testing.Careunity testEmbryos that inherit a particular gene variant, known as the Annexin A5 gene M2 haplotype (also known at Care as C4M2), are at an increased risk of failing to implant or of miscarrying. As the priority at Care is to do everything possible to help our patients, the team have worked on a test that supports identifying one of the causes of miscarriage.The <a href="https://www.carefertility.com/treatments-services/reproductive-genetic-testing/careunity">Careunity screening test</a> can identify the presence of the Annexin A5 gene. If the gene is present in either the sperm or the egg provider, then there is at least a 50% chance that it will be present in the embryo. The test is simple, requiring a swab taken from the inside of the mouth of both partners and results take approximately 3 weeks. If the Annexin A5 Variant is found from either partner, the patient having the embryo transfer will be prescribed a blood thinning medication from the stage of embryo transfer until at least 12 weeks of the pregnancy.How can DNA damage affect fertility treatment?Many factors can cause DNA damage within all cells, including eggs and sperm, but using screening tests such as sperm DNA damage screening and the sperm oxidative stress test can provide an assessment. DNA damage can be caused by factors including your lifestyle factors or age.Sperm DNA damage screeningIf you are struggling with recurrent miscarriage or implantation failure, unexplained or persistent infertility, low fertilisation rates or poor embryo quality in IVF cycles, we would recommend sperm DNA damage screening.For this screening, you simply need to provide a semen sample. The sample is then frozen and transported to our laboratory, where it will be thawed and tested for DNA damage.Sperm oxidative stress testFor up to 50% of couples who require help starting a family, male factors will be the cause of infertility issues. A general semen analysis is often labelled the ‘gold standard’ of assessing the quality of sperm, after analysis 25 - 40% of male infertility cases could remain ‘unexplained’.Oxidative stress is a factor that can cause ‘unexplained infertility’, where high levels of oxidative stress have been linked to poor sperm function and cell DNA damage. Our bodies create antioxidants to minimise levels of oxidative stress, the ability to produce antioxidants is controlled by our genetic makeup but can also be influenced by lifestyle, such as a diet rich in fruit and vegetables. DNA damage is increased by factors such as smoking, alcohol, ageing and a poor-quality diet high in saturated fats and excess weight.As high levels of oxidative stress have been linked to poor sperm function, our <a href="https://www.carefertility.com/treatments-services/male-fertility-health/sperm-oxidative-stress-test">SOS (Sperm Oxidative Stress) test</a> can identify if a patient has high levels of oxidative stress by assessing the balance of DNA damaging particles (known as free radicals) and antioxidants in a semen sample. If the main cause of DNA damage is identified as being oxidative stress, lifestyle changes and antioxidants can be introduced. This test can be done at any time during fertility treatment at Care, or at the same time as a normal semen analysis. Our SOS test is a quick way of identifying whether further testing is necessary.If you are interested in PGT-A, Careunity, the SOS test or would like to learn more, <a href="https://www.carefertility.com/get-in-touch/">get in touch with your Care clinic</a>; our team will be happy to answer all of your questions.

Science Biotechnology DNA illustration and abstract illustration

DNA strands

Audrey Dearing, Principal Genetic Counsellor across the Care Fertility group, explains how DNA affects fertility treatment and how we analyse embryos’ DNA to identify the embryos which are chromosomally normal.

Ishita Mishra - Fertility Specialist - Birmingham

Dr Ishita Mishra

What are Endometriosis and Adenomyosis?Endometriosis is a benign condition where cells similar to the cells of the womb's lining (endometrium) become implanted outside the lining of the womb. This can be in the ovary (forming chocolate cysts or endometrioma), around the womb, within the muscle layer of the womb, fallopian tubes, in the lining of the pelvis and abdomen (peritoneum), vagina, bowel or bladder. While the awareness about Endometriosis has increased in the last few years, little is known about its sister condition- adenomyosis. Adenomyosis is a condition where cells similar to the cells of the lining of the womb implant within the wall of the womb (muscle layer). It is also called Endometriosis of the womb.&nbsp;With every menstrual cycle, the lining of the womb and the endometriosis tissues change in response to the hormones. Whilst the cells of the lining of the womb are shed out in the form of menstrual blood, there is no outlet for the endometriosis tissue. As a result, the endometriosis lesions cause inflammation, pain and scarring. In adenomyosis, the muscle layer of the womb reacts to these uninvited guest cells of the lining of the womb and enlarges in size along with cyst formation.&nbsp;Although the exact cause is unknown, any female in the reproductive age group between menarche (the first menstruation during puberty) and menopause can develop Endometriosis.&nbsp;What are the symptoms of Endometriosis?Symptoms of Endometriosis and adenomyosis may vary and coincide with symptoms of other gynaecological conditions. Some women have no symptoms, whereas others might have severe symptoms affecting their quality of life. Some of the symptoms are:&nbsp;<ul><li>Menstrual pain that limits your routine activity without pain killers</li><li>Pelvic pain or pressure just prior to menstrual period</li><li>Long-term pain all the time in the lower part of the tummy, back, during bowel movements or the top of the legs</li><li>Cyclical pain on opening bowels or emptying the bladder or in the upper part of the abdomen under the ribs just prior to or during periods</li><li>Heavy menstrual bleeding&nbsp;</li><li>Painful rectal bleeding or the presence of blood in the urine just prior to or during periods</li><li>Cyclical cough, chest pain, or coughing of blood just before or during periods</li><li>Cyclical scar swelling and pain just prior or during periods</li><li>Pain during or after sexual intercourse</li><li>Difficulty getting pregnant</li><li>Fatigue</li><li>Depression</li></ul>&nbsp;You may find it useful to record your symptoms using a pain &amp; symptom diary (&nbsp;<a href="https://www.endometriosis-uk.org/sites/default/files/2022-08/pain-symptoms-diary_0.pdf">Event information/materials (endometriosis-uk.org</a>), which can support your discussion with your GP or gynaecologist.&nbsp;How can one diagnose Endometriosis?A pelvic ultrasound scan is a reliable first-line investigation to screen for Endometriosis and Adenomyosis. Usually, this is an internal vaginal scan performed to check the ovaries, the muscle layer of the womb, the junction between the lining of the womb and muscle layer of the womb, the area behind the womb. A scan may not always detect endometriosis lesions at every site involved.MRI is a second-line tool in cases where advanced Endometriosis affecting the bowel and bladder is suspected and where it is difficult to differentiate between adenomyosis and fibroids.&nbsp;Keyhole surgery (laparoscopy) is the gold standard investigation to diagnose Endometriosis and also has the advantage of treating Endometriosis. This is indicated if Endometriosis is suspected clinically and no endometriosis could be detected during ultrasound or MRI. This is carried out under general anaesthesia. Telescope is inserted through small cuts in your abdomen and allows you to have a detailed look at the structures affected by Endometriosis. You may have a biopsy of the endometriosis tissue removed to confirm the diagnosis. In case of severe Endometriosis, a second operation at an endometriosis specialist centre may be required.&nbsp;What are the treatment options?Treatment options are designed depending on individual needs, whether for symptom relief or fertility issues. Some of the treatment options are:<ul><li>Pain killers</li><li>Hormonal medications in the form of pills or injections</li><li>Keyhole surgery to remove or burn the lesions of Endometriosis (cysts on ovaries, lesions around the uterus or in the lining of the pelvis) and to release the scar tissue. This may be combined with hormonal treatment. Surgery for an endometriosis cyst in the ovaries can damage the ovary and may affect your ovarian reserve.&nbsp;</li><li>Removal of the womb if symptoms do not respond to the above treatment options and if you no longer wish to conceive.</li></ul>Measures like dietary changes (cutting out dairy or wheat products from the diet) and regular physical activity may be helpful as well.&nbsp;Endometriosis and fertilityNot all women with the diagnosis of Endometriosis have difficulty conceiving. It is estimated that 30 to 50% of women who have difficulty conceiving after one year of regular sexual intercourse have Endometriosis.&nbsp;At Care, we tailor the management plan in an individualized and patient-centric manner for your fertility journey if Endometriosis is diagnosed. The options include surgery or medically assisted reproduction.In mild to moderate Endometriosis cases, surgery for Endometriosis may improve your chance of getting pregnant spontaneously. Endometriosis Fertility Index (EFI) is a&nbsp;validated tool for predicting chances of conceiving spontaneously after endometriosis surgery and is based on surgical findings, age, years of fertility issues and any prior pregnancy.&nbsp;Fertility treatment, which can include intrauterine insemination (IUI) and in vitro fertilization (IVF), is recommended in the following cases:<ul><li>Moderate to severe Endometriosis</li><li>Endometriosis fertility index suggests low chances of natural conception</li><li>Advanced reproductive age</li><li>Patients with additional factors including blocked fallopian tube, low ovarian reserve, and abnormal semen analysis)</li></ul>Ovarian stimulation at the time of IVF does not worsen Endometriosis and is safe. Having surgery before starting IVF does not increase the chance of pregnancy. It is only recommended if one has significant pain or cannot reach the ovaries during IVF in case of a large endometriosis cyst of the ovary. We can reassure you that patients with Endometriosis have had babies successfully.If you think you may be suffering from Endometriosis, or if you are worried about your fertility, please don’t hesitate to contact your nearest Care clinic to discuss your fertility options. Or you can call our new patient enquiry team on 0800 564 2270. Our expert team will be happy to help you.

Endometriosis and Fertility

If you have Endometriosis, you are not alone - it affects 1 in 10 women and those assigned female at birth; however, this figure may be higher as the condition remains underdiagnosed. Care teams routinely provide fertility treatment to women affected by endometriosis and its sister condition, adenomyosis. Let’s explore some of the key issues about this condition to raise awareness.

Annexin 5 is partly responsible for normal clotting in our body, but if the person carries the M2 variant it may result in blood clotting disorders (sticky blood). We know this variant is carried by about 15% of Caucasians (it differs in incidence in various ethnic groups) but up to 44% of IVF couples[1]. It is also equally present in men and women, so it can be passed on to the embryo equally from the man or the woman if either (or both) are carriers.If this variant passes into the embryo and its placenta after conception, then it increases the risk of early miscarriage (the risk being up to 12 weeks of&nbsp;pregnancy) as well as other potential pregnancy complications.There is a helpful treatment for this condition - women can take low molecular weight heparin (LMWH) to keep the blood from forming tiny micro-clots in the placenta. For couples with this condition, if the woman takes LMWH then it increases her chance of carrying the pregnancy to term from 16% (without treatment) to 42%[2].In our early work, we had to take blood from the couples – it very important to test both the male (if he is providing the sperm) and female, so we were very keen to develop an easy test. However now, working with world-leading molecular geneticists in the US, Care now has a simple saliva test to help us screen our patients: Careunity.How does the Careunity test work?This screening test can identify the presence of the Annexin A5 gene. If the gene is present in either the sperm of the egg provider then there is at least a 50% chance it will be present in the embryo.Testing for it is simple, a swab is taken from the inside of the mouth of both partners and the results are available in about 3 weeks. If the Annexin A5 Variant is identified in either partner the woman having embryo transfer will be prescribed a blood thinning medication called Heparin, better known as Clexane. This is an under the skin injection that starts at the time of embryo transfer and continues until at least 12 weeks of pregnancy.SummaryUp to 44% of couples (22% of women, 24% of men) attending for IVF may be carriers of the M2 variant.Carriers have:<ul><li>4x risk of embryo loss up to 12 weeks of pregnancy</li><li>2x risk of preeclampsia</li><li>6x risk of the baby being small for its gestational age</li><li>2x risk of venous thromboembolism</li><li>2x risk of gestational hypertension</li></ul>1.&nbsp;Fishel, S. et al (2014). Multicentre study of the clinical relevance of screening IVF&nbsp;patients for carrier status of the annexin A5 M2 haplotype.Reprod. BioMed. Online&nbsp;29, 80–87.2.&nbsp;Fishel S, et al (2016). Precision Medicine in Assisted Conception: A Multicenter&nbsp;Observational Treatment Cohort Study of the Annexin A5 M2 Haplotype as abiomarker for Antithrombotic Treatment to Improve Pregnancy Outcome.&nbsp;EBioMedicine:10;298.

Reproductive and Genetic Testing

Over 10 years ago, Care became interested in the discovery of a new gene mutation that could cause miscarriage in early pregnancy. That gene mutation could also cause placenta-mediated pregnancy complications (also known as ‘PMPC’), such as ‘small for dates babies’, pregnancy-induced hypertension, venous thromboembolism or preeclampsia.

For most patients once eggs have been collected, they will be fertilised in the laboratory with your partners sperm, and in some cases with donor sperm.The collected eggs need to be mature to be able to be fertilized. So it is important to realize that only mature eggs will be able to accept a sperm and you may get some eggs which are mature and some which are not. Insemination may be with "standard insemination" by placing the sperm with the eggs or using ICSI. We often use the ICSI technique for patients who have sperm issues. Only mature eggs will be able to fertilize by either technique. So it is important to realize that not all the eggs collected at the egg collection will have the ability to fertilize.Once the eggs are inseminated they will be placed in our laboratory culture system. The following day we will know how many eggs have fertilised to form the initial numbers of embryos to take you to the next stage of your journey. At this stage the embryology team will call you to let you know how many eggs have fertilised to form early embryos.The next very important step is to find out which of the early embryos are the strongest. These early embryos will therefore be cultured in the laboratory following the egg collection. At this stage some of the embryos should have started to grow and increase the number of cells inside them. It is important to realize that not all the early embryos will grow. At this early stage if you have sufficient embryos of good quality the embryology team may recommend extending&nbsp; the culture beyond this early stage to&nbsp; 4, 5 or even 6 days after the egg collection. This extended, or Blastocyst culture, as it is known, allows the strongest embryos to self select and identify themselves as the most likely to result in a pregnancy. It is also important to realize that not all embryos will proceed to this stage - this is entirely normal and part of the process of identifying the best and strongest embryo or embryos for transfer or freezing for treatment in the future. At Care, we also provide our CareMaps-AI time-lapse incubation powered by Artificial Intelligence to select embryos.Rest assured our expert embryology scientific team will be available to update and advise you on the progress and the best plan for your embryos.Depending on the number and quality of your embryos the next step is the embryo transfer which will take place on days 4, 5 or 6 after the eggs are collected. This plan may be modified depending on your individual circumstances, the number of embryos available and if any of our cutting edge technologies - such as Pre-implantation Genetic Testing of embryos (PGT-A) have been recommended by your Consultant.&nbsp;

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Following egg collection, what will happen in the embryology laboratory?

<h3>What is the menstrual cycle?</h3>The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that makes pregnancy possible.The ovarian cycle controls the production and release of eggs and the release of oestrogen and progesterone. These cyclical changes are usually monthly and result in the growth and release of an egg.During the first or preovulatory phase of the cycle, the womb lining sheds, resulting in a period that usually lasts around 4 to 5 days. At this time, oestrogen levels are low, stimulating the brain to make FSH (Follicle Stimulating Hormone).FSH stimulates a number of small egg follicles to start growing in the ovary. By the end of the period, usually, one of these follicles has been selected naturally to carry on growing and become the dominant follicle that starts to produce oestrogen. The production of FSH hormone is reduced, as it is not required again until the next period. The dominant follicle will release an egg that month, and the other follicles die off. A new batch of follicles will begin growing at the start of the next menstrual cycle.The growing follicle releases an increasing amount of oestrogen hormone, which thickens the womb lining in preparation for possible embryo implantation.By around day 12 of a monthly (28 day) cycle, the dominant follicle has grown, and its oestrogen level has risen sufficiently to trigger a rise in another hormone called LH or Luteinising hormone. LH can be detected in urine in simple ovulation prediction kits.The LH surge in the middle of the cycle matures the egg inside the follicle so that it can be fertilised, followed by the release of the egg about 36 to 40 hours after the surge.LH also starts the production of progesterone hormone from the cells inside the egg follicle. Progesterone causes essential changes in the quality of the womb lining, making it receptive to an embryo. It also has a relaxing effect on the uterus muscles.If an egg is fertilised and starts to implant in the womb, signals from implantation encourage the follicle to continue to produce oestrogen and progesterone to help establish a pregnancy. If no such signal is detected, the hormones produced by the follicle reduce, and a period arrives.When the hormones are low, the next cycle of follicle growth, egg release and womb lining preparation begins.What can the menstrual cycle tell us about fertility?Cycle length and regularityThe average length of a menstrual cycle is 28 days, but anything between 26 and 32 is considered ‘normal’. If your cycle is shorter or longer than this or is irregular, the implications may depend on your age and personal circumstances.Additionally, if you have short cycles and but you still ovulate around day 14, you may have a “ short luteal phase” which means that you may need extra progesterone to prolong the post ovulation phase, giving extra time for an embryo to implant properly.Irregular cyclesIf you have very long or irregular cycles in your early teens or twenties, you may have Poly Cystic Ovarian Syndrome (PCOS). PCOS is very common but can make conceiving difficult if you aren’t releasing an egg regularly. PCOS can usually be treated very simply with tablets; you will need an ultrasound scan to see if you have polycystic ovaries.There are other less common reasons for having irregular cycles when you are young, including an underactive thyroid gland or a raised prolactin level. These both give changes in hormone levels which can be detected by blood tests and managed by your GP or gynaecologist.If you have an irregular, shorter or longer cycle in your late thirties or forties, it may be a thyroid problem or high prolactin. It also may indicate that your egg numbers (ovarian reserve) are changing; this can be checked by ultrasound scan and blood tests by your GP or gynaecologist.Long gaps in between periodsIf you do not have polycystic ovaries, long gaps could mean the onset of changes associated with menopause, and a hormone test will help to detect this.Extreme weight loss in younger women can sometimes stop periods, this tends to return once the ovaries have started cycling again.Light or heavy periodsIt can be challenging to describe what a regular menstrual flow is, but if you feel that you have very heavy periods, we recommend that you are checked for fibroids, thyroid gland problems, and hormone irregularities which can cause the lining to be very thick.If you have spotting or bleeding in between periods, you may have a polyp inside the womb; this can be diagnosed via a scan.If you have very light periods, this may be due to age and declining hormonal activity in older women.Painful periodsA little bit of cramping on the first day or two of your period is common, but you should be able to control the pain using simple over the counter medication. Anything more than this over a long time should be investigated, especially if your periods are very heavy.Fibroids and a hormonal imbalance are the most common reasons for painful periods, but some have endometriosis. Endometriosis can cause severe pelvic pain, even starting just before your period arrives.&nbsp; If your GP or gynaecologist thinks you may have endometriosis, you may be referred for a laparoscopy to treat it.What can your menstrual cycle tell you about your fertility?We can learn a lot from your menstrual cycle, including all of the things already mentioned above.As a general rule, a regular cycle, however long or short, usually means that you are ovulating (releasing an egg). You can use home testing kits to confirm that you have an LH surge which helps you to time intercourse efficiently. You can also get a blood test for progesterone level about a week after your presumed ovulation; this will confirm if you are ovulating.Some women notice a change in the consistency of normal vaginal discharge, which occurs around ovulation. Discharge can become more abundant and watery due to rising oestrogen hormone levels. The mucus discharge is thicker at other times of the month.If you are under 37, have signs of ovulation, have regular cycles, and have been trying for a baby for some time, the reason is likely something other than your ovulation cycles.Frequently asked questionsQ: When are people most fertile?A: An egg should be fertilised within 12 to 24 hours of release, so it is essential to time intercourse around ovulation. Sperm can last in the genital tract for up to 72 hours, so it makes sense to have intercourse from just before ovulation (just after your LH surge if you are testing for this).There are many apps available and urine testing kits that can help you time sex efficiently to maximise your chances.Q: How can contraception affect your menstrual cycle?A: Taking the combined pill will usually give you a false but regular withdrawal bleed in the seven days when you don’t take it. The oestrogen in the pill stops you from ovulating hence its contraceptive action.When you stop taking the pill, most people will start having a regular ovulatory cycle immediately. However, the return to normality can take a couple of months for some.The progesterone-only pill can give you very irregular bleeding or very light and infrequent periods. The contraceptive implant can also stop your periods and take some months for the cycle to return to normal once it is removed.The coil (IUCD) can give you heavy periods if it is a simple copper coil, and cycles should return to normal straight away after it is removed. The Mirena coil, which releases hormones, can make your cycles disappear or become irregular. Again, it may take a month or two for your periods to return to normal after its removal.Care are on hand to offer expert advice. From <a href="https://www.carefertility.com/treatments-services/assessments-tests">fertility tests</a> to advice on <a href="https://www.carefertility.com/where-to-start/causes-of-infertility/optimising-your-fertility">ways to increase your fertility</a>, we are here to support you.With love from Care x

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Many find the menstrual cycle a helpful way to understand your body. If you are beginning to consider your fertility, you might not know where to start; at Care, we are here to support and guide you at every stage of your fertility journey.

This might be useful if you have moved house, are considering treatment at an alternative IVF Clinic or are already receiving treatment at another Clinic. It is even possible to import frozen samples from a Centre outside the UK.It might seem like a risky business, transporting precious cargo such as human embryos or sperm, but it is actually an extremely safe and easy process, in fact hundreds of patients have successfully moved their samples to Care over the last 19 years since Care was established. And, you don't have to do it yourself!Using your frozen embryos and sperm at CareCare is particularly experienced in receiving frozen embryos and sperm from other clinics and advises a specialized courier service to do the physical transportation. Care will help to arrange the transport, which involves the use of a small tank designed to hold samples at temperatures of -190C for many days, the perfect conditions for frozen embryos and sperm. Care embryologists ensure the samples are safely stored on arrival.When it comes to using or thawing the frozen samples, the embryologists are able to thaw the embryos or sperm in just the same way as the original Clinic, so treatment is not compromised in any way.It may be that not all the samples are used in treatment and long-term storage is needed, again this is fine as there will be ample safe and secure storage facilities that will hold that precious cargo for many, many, years.For more information please contact the Embryology team at your Care clinic. Patient information documents are available to guide you through the process.

Egg/sperm/embryo freezing - vitrification with liquid nitrogen

Egg/sperm/embryo freezing

You may not know that if you freeze your embryos or freeze your sperm at another clinic, they can be safely transferred to any IVF Clinic in the UK for storage or fertility treatment; they don't have to be stored at the Clinic they were originally frozen at.

Take eggs for example. I remember the ‘Go to work on an egg’ campaign which portrayed eggs as the perfect breakfast food: high in protein and low in calories. Then eggs were found to be full of ‘dangerous cholesterol’ and people were told they could only eat the white but not the yolk (the tasty bit!). Now eggs are back in foodie fashion again! &nbsp;Some nutritionists take the view that all food is just basically fuel and whether the calories come from protein, fat or carbohydrate doesn’t really matter so long as the total number (2000kcal a day for an average active young woman) isn’t exceeded.But some interesting research in America suggests that for IVF patients at least, it really might matter where the calories come from!A clinic in California identified a group of IVF patients who weren’t doing as well as expected.&nbsp; They were young, normal BMI and normal ovarian reserve but this group didn’t respond so well to the drugs; got fewer eggs, lower numbers of top quality embryos and fewer positive pregnancy tests. Those that did get pregnant had a higher miscarriage rate.&nbsp; So what was going wrong? The team asked them to keep a ‘food diary’ and found that although they were having the right number of calories per day (about 2000kcals is perfect for active young women), almost all their calories were coming from carbohydrates. They would have cereal and toast for breakfast, a sandwich for lunch, pasta for supper and their favourite snacks were crisps and biscuits. Over 75% of their daily calories were Carbs!The ‘food diaries’ of the ‘normally’ successful group were very different: they had more protein and lots of leafy vegetables and fruit. Their live birth rates were almost double those of the ‘high carb’ patients.When PCOS patients (who may need help with weight loss) have followed a ‘low-carb’ plan they often found that the ‘low carb’ eating plan assisted their efforts to shed those stubborn pounds. This is not too surprising as part of the problem that PCOS women face (and the reason why they are five times more likely to develop Type 2 Diabetes) is that they don’t handle sugar properly. We then started recommending it for all patients (and encouraged their partners to join in as over-weight and obesity has been shown to reduce sperm quality too).The ‘sperm cycle’ is about 70 days so it takes over 2 months to see the benefit of lifestyle changes on the chaps’ sperm function. In just the same way, dietary and nutritional&nbsp; changes for women need to be started 2-3 months before a treatment cycle as the eggs we will be collecting for IVF or ICSI actually started developing 3 months before she even starts her treatment cycle drugs.This sort of Fertility Nutrition plan we have been advocating has now been given a huge boost by the publication of a paper in Human Reproduction, one of the world’s leading fertility journals, which claims that a ‘Mediterranean diet’ may help young women receiving IVF to boost their chances of achieving successful pregnancies.The researchers, from a University in Athens, Greece, asked women about their diet before they underwent an IVF treatment and found that those who ate more fresh vegetables, fruit, whole grains, legumes, fish and olive oil and less red meat and simple carbohydrates had an almost doubled live birth rate compared to young women who ate the ‘poorest’ diet. The effect was not so clear for women aged over 35 years where other factors can influence IVF outcome.Half of all women in the UK having IVF are 35 or under so wider knowledge about the role of good nutrition for fertility is absolutely vital.<a href="https://www.carefertility.com/where-to-start/top-tips-for-improving-fertility/">Here are more top tips for improving fertility.</a>

Nutrition (veg)

It is well known that some of the poorest parts of the world, where nutritional levels are low, also have very high birth rates. By contrast, the majority of IVF cycles take place in countries with a much higher per capita income and which could be assumed to have much better nutrition. There is a bewildering array of dietary theories around today and the pronouncements of ‘experts’ seem to change on an almost daily basis.

“From a fertility Doctor’s point of view, despite miscarriage being a very upsetting and unwanted complication of pregnancy, it’s an encouraging sign because if you have managed to get pregnant once, you'll get pregnant again” Often, women can feel utterly helpless, as do their partners and immediate family. This often leads to statements from your loved ones which are meant to be helpful and encouraging but in fact, are anything but. "Don't worry, you can always try again' or words to that affect can be hurtful and make you feel worse. Remember, your body has areas undergone many changes in anticipation for the pregnancy and simply cannot just reset itself instantly.It is essential therefore, that following an unexpected pregnancy loss, irrespective of how many weeks pregnant you were, you need to grieve, and grieve properly. Often you are grieving for the child you never saw which can be particularly difficult.Commonly, we have a misconception of what a miscarriage or pregnancy loss is, especially when it happens in the early stages. We have this perception that inside the uterus there is a tiny well-formed baby, hanging on by his fingertips, shouting "please mummy, don't let me fall out," and somehow when it happens, it is our fault.Well, this is simply not true; a good number of human embryos that are created either naturally or in the laboratory, as with IVF, are chromosomally abnormal. As we get older, the number increases. When a woman reaches the age of 35 this can be over 50 percent. By the time she reaches 40, over three quarters of the embryos she creates are, in fact, chromosomally abnormal.The female human body has a very sophisticated mechanism of recognising these fetal anomalies: the messages sent to the uterus from the growing baby result in one of two things happening: either, the uterus just lets the abnormal embryo pass through the body without allowing it to implant into the wall of the uterus, or if it is unsure, the uterus will allow it to implant. The body will then monitor the growth and development of the baby for a few days or weeks. If the baby is normal, the uterus will keep hold of the developing pregnancy. If it detects a significant abnormality, the uterus will let the pregnancy go or expel it.Ninety seven per cent of all early miscarriages, i.e. those before 12 weeks gestation, are chromosomally abnormal.If you think of it another way, the commonest chromosomal abnormality is Downs Syndrome.It is estimated that for every one hundred Downs babies conceived, only one is ever born, the remaining ninety nine per cent will be lost through miscarriage.As a general rule of thumb, up until twelve weeks of pregnancy, by far the commonest cause of miscarriage is through fetal abnormality. After twelve weeks of pregnancy, it becomes less likely that the baby is abnormal and more likely that there is a maternal component to the miscarriage.It is for these reasons that if a pregnancy threatens to miscarry, it is often best to let nature take its course. There is very little a doctor can do to stop an early pregnancy from miscarrying. Giving lots of hormones is not the answer. If a pregnancy is normal, it will stay put and simple advice such as rest will suffice. If the pregnancy is abnormal, the chances are, it will not survive.It is uncommon for a normal pregnancy to miscarry in the first twelve weeks.One final point; it is a complete myth that you should not try for another baby immediately following a miscarriage. There is no scientific basis for this unless you have suffered a medical or psychological complication. As a matter of fact, it’s quite the opposite. Women tend to be more fertile following a miscarriage.From a fertility doctor’s point of view, despite miscarriage being a very upsetting and unwanted complication of pregnancy, it’s an encouraging sign because if you've got pregnant once, you'll get pregnant again. Except this time - with a bit of luck - it will have a better, happier outcome.

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Miscarriages can be devastating, especially if you have undergone fertility treatment or have been trying for a long time to pregnant in the first place.

Taking long-term contraception can make you infertileIt is unlikely that contraception can affect your fertility. Some conceive immediately after they stop using contraception, and others may experience a temporary disruption to their menstrual cycle.Contraception is unlikely to affect your fertility, but it can hide a potential underlying problem, such as irregular periods.Most people conceive quickly Everybody has individual circumstances that can affect how long conception may take, so it would be wrong to say that most people conceive quickly.Approximately 1 in 6 may have difficulty conceiving; infertility is usually only diagnosed if you haven’t a year of trying. If you are concerned, we recommend that you speak to your doctor or <a href="https://www.carefertility.com/contact-us/?id=book">book a consultation</a>. Age only affects female fertility We are often made aware that egg quality naturally starts to decline when people are in their early 30s. A third of all eggs have chromosomal abnormalities by the time a person turns 40, making the eggs unable to form a viable pregnancy.Male fertility starts to decline from around 40 to 45 years of age; as testicular function and sperm parameters deteriorate.&nbsp;The only solution when struggling to conceive is IVF IVF is not the only solution when experiencing infertility. Although<a href="https://www.carefertility.com/treatments/ivf-in-vitro-fertilisation/">IVF</a> may be the right option for you, there is a vast range of treatments available. At Care Fertility, your treatment plan is bespoke and individualised to ensure your personal needs are met, these include:<ul><li><a href="https://www.carefertility.com/treatments/ivf-diagnostic-tests/">Diagnostic tests</a>: we would recommend this to achieve an accurate diagnosis before pursuing treatment</li><li>Fertility drugs</li><li><a href="https://www.carefertility.com/treatments/intrauterine-insemination-iui/">Intrauterine insemination</a> (IUI) </li></ul>Irregular periods signify infertility Irregular periods don’t always indicate a problem; factors such as weight loss or weight gain, stress or hormones can affect your menstrual cycle.The average menstrual cycle lasts 28 days, although it can be longer or shorter. An irregular cycle can make it challenging to know when your fertile window is, and you may not ovulate regularly.We recommend that you speak to someone if you have irregular periods, especially if your period lasts over 7 days or your periods have suddenly become irregular.Good health means good fertility <div class="embedded-entry redactor-component block-entry" type="entry" data-sys-entry-uid="blt0febbd2167ff557e" data-sys-entry-locale="en-gb" data-sys-content-type-uid="image_component" sys-style-type="block"></div>You can be in good health and still struggle with conceiving; good health doesn’t guarantee ‘good fertility’. From ovulation disorders to blocked tubes, there are many factors that could contribute to infertility; we are here to help.We recommend that when trying to conceive that you:<ul><li>Eat a balanced, nutrient-rich diet</li><li>Exercise regularly</li><li>Avoid excessive alcohol, and reduce caffeine intake</li><li>Avoid smoking</li><li>Manage your stress levels </li></ul>Our&nbsp;teams are here to help, support and guide you at every stage of your fertility journey. We believe that family is for everyone and we will do everything we can to help you. To find out more, and get answers to your questions, you can call our new patient enquiry team on 0800 564 2270. They have lots of knowledge and experience and they'll be happy to help you.

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As soon as you begin to research fertility online, you will find lots of information and some of it can be confusing. Our teams at Care are experts in fertility science and we can debunk some common fertility myths to help make things easier to understand.

At Care Fertility, we want to make the process of egg donation as easy and straightforward as possible and give you all the information you need to decide whether <a href="https://www.carefertility.com/donation/donating-your-eggs/" target="_self">egg donation</a> is right for you. That’s why we’ve put together some of the most commonly asked questions by women considering donating their eggs, to help you decide.What are the criteria for donating eggs?<ul><li>You must be between 18 and 35 years old</li><li>You need to be fit and healthy, with no family history of hereditary illnesses</li><li>For your safety, we can only accept donors with a BMI below 35</li><li>You should be a non-smoker (this includes vaping)</li></ul>If this sounds like you, <a href="https://www.carefertility.com/contact-us/donate-your-eggs/" target="_self">click here</a> to fill in our egg donation enquiry form, and one of our expert team members will be in touch to arrange a date for you to visit the clinic for your assessment tests. What are the benefits of donating my eggs?Egg donation is an opportunity to give someone the chance of becoming a parent, and it can be a truly rewarding experience. Your generosity can make a real difference to someone’s life and there are some great benefits to donating:<ul><li>Free fertility assessment: As part of the donor screening process, you’ll receive a free full fertility assessment. You’ll have a test to assess your levels of Antimullerian Hormone (AMH) and an ultrasound scan called an AFC, these will indicate your ovarian reserves, giving valuable insight into how you might manage your own fertility in the future.</li><li>Compensation for your time: all our egg donors receive a payment of £750 per donation cycle to cover any expenses incurred while taking the time to donate.</li><li>Giving someone the precious gift of parenthood: Having IVF treatment with donated eggs can increase chances of success from &lt;5% to potentially over 80%, removing the pain of unsuccessful treatment and miscarriage so you know you’re truly making a difference.</li></ul>How many times will I have to visit a Care Fertility clinic?This will vary slightly from person to person but you will usually visit the clinic between 5-7 times. You will need to visit the clinic for your scans and blood tests, in between these appointments at the clinic, you’ll also have a number of virtual (either telephone or video call) appointments with our lovely donation team. Depending on your availability, we could bring you through to donation in as little as 12 weeks from your application.Apply to donate – fill out our quick to register your interest in becoming an egg donor by <a href="https://www.carefertility.com/contact-us/donate-your-eggs/" target="_self">clicking here.</a>Complete a medical questionnaire - You will be asked to fill in some online medical questionnaires, including details of any genetic illness within your family. This will be reviewed by one of our doctors, who will decide if you are able to proceed.Phone appointment - You will have a phone appointment with one of our Registered Practitioners in Fertility Care (nurses/ midwives) to go through your forms and discuss the donation process in more detail.Fertility assessment – you’ll come into the clinic for a vaginal scan and a hormone blood test to check how many eggs you have and to scan your womb and ovaries.Further blood tests – to screen for infectious diseases.Counselling session – After you’ve talked through the process with our donation team, we’ll also invite you to meet one of our experienced counsellors. This is a good chance to ask any questions you have and discuss the implications of donating your eggs.Online consultation – Once you’re happy to go ahead with your donation, you’ll meet again with one of our Registered Practitioners in Fertility Care (Nurses/ Midwives) - this is usually done online. They’ll describe the donation journey in detail, and look at when you may be able to start treatment. If all is well, things can move quickly; you might start the process as soon as two to four weeks later.Starting treatment – you will begin your injections to stimulate your ovaries. You’ll need to give yourself daily injections for around twelve days, which we’ll teach you how to do.Monitoring – you may have one or two monitoring scans once you have started your stimulating drugs to monitor the progress of your eggs.Egg collection – We’ll collect your eggs during a non-surgical procedure. It is typically done under mild sedation or local anaesthetic; you will not need a general anaesthetic. No incision is made, and no stitches are necessary!Compensation - You will receive your compensation payment within two weeks of your egg collection.Will I need to take time off work to donate?We'll do whatever we can to make sure your donation isn't too disruptive. During the short monitoring stage, we'll need you to attend the clinic on specific days, but the appointments won't take long and can be scheduled to suit you where possible.It will be necessary to take the day off of work on the day of your egg collection. Sometimes, donors feel more comfortable if they also take the next day off after their egg collection, but this is generally not necessary.In reality, you should only have to visit the clinic around six times, but we'll give you as much support as possible to make sure your visits are convenient and stress-free.Will donating my eggs affect my own fertility?No, not at all – and it can give you an insight into your own fertility potential!Women are born with all the egg cells they are ever going to have, between 1 and 2 million. By the time you’re in your 30s, you’ll have around 75,000 eggs left and each month you lose up to 1,000 eggs in a natural cycle, even though only one egg is naturally matured for fertilisation.This means that the eggs we collect during your donation would either have been ovulated or absorbed by your body, and if you donate eggs, you’ll still have thousands of eggs left. Many of our donors even donate more than once.Does egg donation hurt?No, you shouldn't feel any pain. You may feel some discomfort, and of course different people respond differently to medical procedures, but our clinical teams work incredibly hard to keep you as comfortable as possible throughout your donation.In the UK, there is a shortage of egg donors of all ethnicities, and many more eggs are needed to help women and couples to achieve their dream of having a baby. If you think you could give the gift of life or have any further questions or concerns regarding egg donation at Care Fertility, please don’t hesitate to get in touch with us.<a href="https://www.careweb-dev.salveemr.com/contact-us/donate-your-eggs/" target="_self">Donate your eggs</a>

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Are you considering donating your eggs? Helping someone else to have a family of their own is a generous and rewarding experience for any woman to do. 

As an <a href="https://www.carefertility.com/donation/donating-your-eggs/" target="_self">egg donor</a> you have the opportunity to change lives, and we want you to be fully informed of the process involved in this incredible journey. Egg donors have to attend a range of appointments at a Care Fertility clinic, in this guide we explain each step of egg donation and what it will mean for you.Questionnaires and testsWe ask all of our donors to fill out a medical form and family history questionnaire. These forms are a legal requirement for all fertility clinics and help us to distinguish whether you are suitable for egg donation. They are relatively simple and easy to complete, and our donation teams are there to help with any questions you have.After your consultation with one of our Donation Coordinators, you will undergo blood tests and a quick ultrasound scan so the team can assess your fertility health.AppointmentsOnce you have decided to go ahead with your donation, you’ll need to visit the clinic between seven and ten times. We’ll do everything we can to ensure your appointments aren’t too disruptive to your day-to-day life.After your first consultation and initial blood tests, you will normally then have an appointment with a Care counsellor. Here, you will be able to talk through the ethics of egg donation and any queries you may have, or emotions you may be feeling towards the donation process. Following this, you will have a consultation with a doctor who will answer any of your medical questions. You will then be scheduled in for three to five monitoring appointments, and one final appointment for egg collection.Self-administered injectionsWomen who choose to donate their eggs are required to administer injections in order to stimulate their ovaries in preparation for egg collection. These injections stimulate egg production, ensuring the optimum number of eggs are matured and ready to be retrieved on collection day. The nurses will make sure you fully understand the process, and are comfortable to do this before leaving the clinic.The injections are easy to administer, and can be done in the comfort of your own home. If you do feel you are unable to administer the injections yourself, it may be comforting to ask a partner, friend or family member to help you carry this out.AnonymityIn 2005, the laws regarding egg and sperm donor anonymity changed to allow any child born from donated eggs or sperm access to identifiable data about their donor when they turn 18 years old.However, it is important to understand that you will not be financially or legally liable for any children born from your donation. The recipients of your donated eggs are the legal parents of any child born as a result.If you decide&nbsp;that you would like counselling, our Care Fertility counsellors are available&nbsp;to chat with you. They can&nbsp;advise you on things like the information&nbsp;that would be given to any children&nbsp;born from your donation and answer any questions you may have.We’re here to give you all the facts, and support, you need to give another woman the chance to have a family of her own. So, if you have any further questions or concerns regarding egg donation at Care Fertility, please don’t hesitate to get in touch with us by <a href="https://www.carefertility.com/contact-us/" target="_self">clicking here</a> or calling us on 0800 564 2270.

Becoming an egg donor is a generous and rewarding experience, knowing you will be making a difference to couples and individuals wanting to start their own families. 

When it comes to building a family, understanding what fertility options are available is key. Over the years, the LGBTQIA+ community has witnessed incredible progress when it comes to fertility options. Thanks to advancements in reproductive technology, individuals and couples from all sexual orientations and gender identities now have a range of empowering paths to parenthood. Whether it’s same sex male couples exploring the possibilities of IVF &amp; Surrogacy, same-sex female couples considering IVF using donor sperm or transgender and non-binary people considering fertility preservation prior to commencing hormone therapy or surgery, the journey to parenthood has become more accessible than ever before. Whether you're ready to start a family, future planning or just curious, understanding and being in control of your fertility is really important. We want to empower all patients in the LGBTQIA+ community to make more informed decisions about all aspects of fertility, not just when they’re ready to start a family. Let's take a look at what options are available for:Male couples &amp; single men<div type="entry" class="embedded-entry redactor-component block-entry" data-sys-entry-uid="bltfce25dc1430b9318" data-sys-entry-locale="en-gb" data-sys-content-type-uid="image_component" sys-style-type="block"></div>If you’re not quite ready to start a family just yet, fertility preservation is a crucial consideration for couples/single men planning to start a family in the future. Sperm freezing and storage is a hugely popular option that allows men to preserve their sperm and maintain the option of parenthood later on in life. This involves collecting and freezing sperm samples, which can be stored for up to 55 years, that can be used in treatments such as Intrauterine Insemination (IUI), In Vitro Fertilisation (IVF), or used in Surrogacy.&nbsp;Over the years, surrogacy has become a remarkable path to parenthood that has brought joy and hope to countless couples and individuals. Through the generosity of surrogates, this life changing journey has allowed gay men and male couples to fulfill their dreams of parenthood. Surrogacy involves a legal arrangement where a woman (known as the gestational carrier/surrogate mother), carries a pregnancy on behalf of the intended parents. For male couples, this treatment allows one partner's sperm to be used with a donor egg &amp; transferred into the surrogate's uterus through IVF. Surrogacy offers gay men the chance to experience the incredible journey of biological parenthood, whether your parenthood journey involves a partner or you’re embarking on this journey as a single parent.&nbsp;&nbsp;Surrogacy also requires the use of donor eggs, you can either use a ‘known donor’ or access the Care egg bank. The aim of our egg bank is to give our patients a wide choice of donors with little or no wait. You will be able to select your egg donor online and then have your treatment at one of our world leading clinics. As a leading provider of egg donation treatment in Europe, we truly understand our patient's needs and care about your future family. We have meticulously crafted our cutting-edge egg banking and donation programme with you in mind. We freeze eggs with a process called vitrification that allows eggs to be frozen and thawed successfully without being damaged. This method freezes eggs instantly at -196⁰C using liquid nitrogen and is so effective that an estimated 97% of eggs survive the freeze-thaw process.Thousands of babies have now been born worldwide from treatment using previously-frozen eggs. Thanks to state-of-the-art technology, using frozen donor eggs offers a more flexible approach to treatment. Embryo transfers can be done immediately, in line with natural cycles or at a time that best suits you. Using frozen eggs also gives patients more certainty, not only is there a shorter waiting time for treatment, but because we have already carefully collected and frozen the eggs the risk of treatment disruptions (as sometimes experienced with fresh eggs) is little to none.&nbsp;Female couples &amp; single women<div class="embedded-entry redactor-component block-entry" type="entry" data-sys-entry-uid="blt2ea9a7d91ca82309" data-sys-entry-locale="en-gb" data-sys-content-type-uid="image_component" sys-style-type="block"></div>If you’re not quite ready to start a family just yet, fertility preservation is a crucial consideration for couples/single women planning to start a family in the future. For LGBTQIA+ females, the most common method of fertility preservation is egg freezing. Whether you’re planning to conceive with a partner or as a single parent, egg freezing allows patients to proactively plan for their future family. This involves retrieving eggs from the ovaries, freezing them and storing them for later use. The standard storage period for eggs is 55 years, requiring a renewal of consent every 10 years, but there may be circumstances in which your eggs can be stored for longer (e.g. for those women at risk of becoming prematurely infertile due to medical reasons). When you feel ready to start your path to parenthood, your eggs will be thawed to be fertilized with sperm (from a donor or partner) and transferred into the uterus through IVF.&nbsp;Thanks to advancements in reproductive technology, Shared Motherhood (also known as reciprocal IVF), is an innovative treatment that allows both partners in a same-sex female couple to experience and share their journey to parenthood. This incredible treatment option enables one partner to provide the eggs, which are then fertilized with donor sperm, and transferred to the other partner's uterus and who then carries the baby as the ‘gestational or birth mother’.&nbsp;Transgender &amp; Non-binary peopleNavigating through the trans journey can be a difficult, challenging, and overwhelming experience when you're living in a body that doesn't reflect your authentic self. Although it's likely that fertility is the last thing on your mind, we're here to help answer any of your fertility questions.If you are planning to start your transitioning journey, it is important to consider what impact the treatments associated with transitioning will have on your fertility. These effects may be irreversible, so if in the future you wish to have children, preserving your fertility may be the answer.When you feel ready to start the next stage of your fertility journey, there are a number of future treatment options. These range from treatments such as IVF and intra-cytoplasmic sperm injection (ICSI), to surrogacy and using donor eggs/sperm. Our doctors will discuss all available options with you at your first consultation. One of the most important things you can do during your fertility journey is have a support system. Support comes in many forms: friends, family and even those who are not directly involved in your journey can help make you feel less alone and more supported.&nbsp;Whether you’re ready to start a family, trying to conceive or going through treatment, we believe that every person deserves access to the best fertility care available – and that includes accessible treatment options, a supportive community and helpful resources. Our goal is to help you feel confident about your choices and be empowered by the knowledge and support our dedicated team provides.&nbsp;

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In today’s ever-evolving world, the paths to parenthood for the LGBTQIA+ community have become more diverse and empowering than ever before. We believe that family is for everyone, regardless of relationship status, sexual orientation or gender. From same-sex couples to transgender and non-binary individuals, we’re proud to offer personalised treatment plans to make dreams of family a reality. 

For over 45 years, the remarkable scientific breakthroughs of IVF have helped thousands of patients across the globe to fulfil their dreams of having a family. While the spotlight is often on the pioneering technology, state of the art laboratories and doctors, today we would like to recognise the dedication, support and expertise of our nurses who work tirelessly behind the scenes. Our goal is to help patients feel confident about their choices and be empowered by the knowledge and support our dedicated team provides - with nurses playing a pivotal role in patient education. Sometimes the world of fertility can be quite complex and overwhelming, particularly if it’s your first time undergoing treatment.&nbsp;Like all medical experts, nurses dedicate a huge amount of time explaining the intricacies of fertility, the treatment processes, as well as the potential risks and benefits of procedures to patients. On hand to answer questions with patience and compassion and help clarify any doubts, nurses are a reliable source of knowledge, and play a key role in helping patients feel empowered and equipped to make decisions about their fertility.&nbsp;But it’s not just from a technical aspect, sometimes it’s the emotional support nurses provide that makes the world of difference. Fertility treatments can take their toll on patients and their loved ones both physically and emotionally, it can be a rollercoaster of emotions at times, particularly when patients are faced with uncertainties and challenges. This is where the power of a nurse shines through. A shoulder to lean on, a knowledge bank and a constant support to patients and their loved ones every step of the way, their guidance and comfort helps patients navigate their way through the highs and lows of the fertility journey.&nbsp;Recognising remarkable careTo mark this year’s International Nurses Day, we are proud to announce we are joining the Global DAISY Award scheme to recognise and celebrate the invaluable impact our nurses and midwives have on IVF and Fertility. Their tireless dedication, compassion and wealth of knowledge has helped change the lives of countless patients looking to start a family.The DAISY Award was established in 1999 by the family of J Patrick Barnes who sadly passed away at the age of 33 from complications of ITP. His family were completely awestruck by the care and compassion that they and Patrick were shown during his 8-week illness, which inspired them to create an award to recognise the exceptional care nurses provide. For 22 years, DAISY has been honouring extraordinary nurses around the world. There are now over 5,400 healthcare organisations and schools of nursing who are DAISY partners, and we’re proud to be the first independent IVF provider to join the global scheme.This award provides patients with a unique opportunity to express their gratitude and admiration for the care they received. Patient and family gratitude for a nurse’s extraordinary compassionate care is the most meaningful thank you a nurse can receive, and we're proud to recognise our nurses with this award.We encourage all patients to take a moment to nominate their nurse, <a href="https://forms.office.com/pages/responsepage.aspx?id=0S1OvdGsAUW9bje7TTrV9Gq9ncbRzJxNiu4KmiAXy6xUOFUzU0xHNDNaSVZXQzRMNlRPQk9SRldUVC4u">click here</a> to share your story of what your nurse has meant to you. We don’t want you to miss the opportunity to celebrate your nomination, so stay tuned on social media where we’ll share the proud recipients of the prestigious DAISY Award!

Sheffield Nursing team

Nurses play a pivotal role in comforting and guiding patients throughout treatment. They bring a unique blend of medical expertise and emotional support, providing patients with endless reassurance, guidance and care throughout their fertility journey.


<div class="embedded-entry redactor-component block-entry" type="entry" data-sys-entry-uid="blt6c7a1d6a5c01ad9b" data-sys-entry-locale="en-gb" data-sys-content-type-uid="quote" sys-style-type="block"></div>We all know it’s hard for men to talk about infertility given what’s at stake – their masculinity, social standing, that chip off the old block not happening. ‘Strong, silent, provider’ is a deeply engrained code of honour. And there are other factors too, that are holding men back from being more involved when it comes to matters fertility. With the risk of making one or two gender-based generalisations, and with assurances that I know, having watched my wife go through it, just how life-shattering the whole fertility thing is for women – here’s some thoughts on this subject.It’s a strange state of affairs, when you think about it. Because when it comes to infertility, around 50% of causes are male-factor traced (a little known and talked about fact in itself).Once a man’s sperm is proved to be sufficiently active and mobile, and he’s had his moment in the sample room, then of course he has to take a necessary step back. It’s his partner’s stage now, everything happens to her: drugs; mood swings, retrieval and implantation, DIY jabs and all. But he’s still just as emotionally charged and vulnerable as she is.Sure, if you’re amongst the 1 in 20 men affected by sperm inefficiency, then of course you’re under the initial spotlight (only an unfortunate 1 in 100 men has an absence of sperm altogether, a condition known as Azoospermia). But these men too, once they’re through their rounds of tests and treatments, give exactly the same evidence when it comes to feeling like a spare part.Surely there is reason and room for change here, as men experience the highs and lows of their shared cycle, all that waiting, preparation, treatment and result? Clinics, HCPs, counsellors – everyone, family and close supporters included. They all need to do more to engage and empower men around the treatment so that they really do co-own and share that cycle. After all, it is just as much theirs; a life changing several weeks, months and quite often years for them too.My own fertility trip is over, at least the coal-face years of it (it never quite goes away, that biological, heart-felt tug of the sleeve that every now and again steps out of the shadows). After four failed rounds of IVF – the first three with London’s ARGC and then a final role of the dice in Las Vegas – we retired exhausted and wounded from the fertility front. After a break, as we reflected on my wife’s diminishing egg quality and her suspected immunology issues, we considered and rejected both donor-egg and surrogacy. And after another break, we got used to the idea of adoption, then signed up for the home study. Eventually, some nine years after the initial, de-railing discovery of our infertility, we were placed with our infant son. A momentous day, and several bonkers years later (family life!), it’s been a pretty good story, for all of us. (I’m a big fan of adoption and always happy to talk about our experiences.)More recently, I pitched myself back into the world of fertility when I wrote a book about it. There were several reasons for writing it, not least to boost my own understanding and acceptance around that long stage of our lives. But also, because very little of what I found to read on fertility was written by men, exploring the subject from a male perspective. Books, forums, clinic chat groups, articles across a whole range of publications, print and online – nearly all of the content written by women. So, I thought, given that around 50% of the 1 in 7 couples finding it tough to conceive were men, there’s got to be some readers out there.The book is for men&nbsp;and&nbsp;women going through it all, but where it feels right, I have purposefully landed on the maleness of the journey – mine, and many others.Some of that male territory is more obvious (predictable, perhaps!). For example, a few stories from the porn-strewn confines of the sample room. One from a work colleague who dreaded his solo mission so much he smuggled his partner in there to help him out. And when one day she wasn’t available, he fled the clinic and managed to book himself and his jar into a Travel Lodge, for free. And a chase story – a man whose wife tracked him down on an overseas work trip to phone him with the news that she was ovulating and, much to his surprise, was ready and waiting in his hotel room. There’s much humour amongst the spills and thrills of a fertility journey – the more we can lighten its considerable load, the better.It also covers male-orientated experiences and events of a more sensitive nature. Sex (not surprisingly) features strongly: how fertility issues have a way of shredding our once treasured sex lives like nothing else. Other differences, tensions and issues that we find driving wedges between us. What happens between men and women, when they need to be at their strongest and most together, when they are taken to the very limits of what humans can possibly bear and eventually live with? Several men generously contribute their stories. It is, by all accounts (mine included), a perfect shit-storm to find yourself caught up in. But going quiet, as men do, is the worst way to deal with it. Instead of tackling the loss and grief-like sadness together, a couple can drift, lock each other out, eventually part. The book covers what we can do to help ourselves, and our partners, to become (despite everything) a stronger couple for it. Counselling is the obvious help-at-hand, but there are plenty of self-help tools in the box too.Today, thankfully, there are lights at the end of tunnels for men going through it. Right across the health landscape, from Prostate Cancer to that hot potato mental health, silence and stigma are turning to talk and support. A Face Book group, for example, called ‘Men’s fertility support – a secure place for men only to talk’. How brilliant that there’s now such a group for men to share their hopes, fears and experiences, to support each other through their losses, and on red-letter days, to celebrate their good newsOnwards! With thanks to Care Fertility for providing this platform and wishing everyone the best possible outcomes on their roller coaster rides – both men and women, together". Gareth Downs, Founder of Men's Fertility Support

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"I have heard it time and time again from men on the roller coaster ride of fertility treatment – that their role, presence and feelings, when compared with those of their women co-pilots, are at best side lined, at worst ignored" Ripping up the Script is an entertaining read about fertility. "The more men’s voices are out there, the easier it will become for us to talk about it.” (Gareth Down, founder of Men’s Fertility Support.)

When it comes to IVF, it is beneficial that both partners are happy, healthy and fully prepared for their treatment. We want you to get the very best from your treatment, so we have created our 5 top tips on how men can prepare for IVF to ensure you are getting the most of your time with us.<ol><li>Improving your diet. It has been proven in recent research that men’s diets are affecting their fertility just as much as women’s. By ensuring you’re eating lots of fruit and vegetables, and a range of nutritious foods, you can help create and maintain healthy sperm. Nutrients such as Vitamin B9 (folate), Omega 3 and Vitamin D are key to keeping your sperm in tip top condition. </li><li>Watch where you're getting your protein. Another important factor in sperm production are the sex hormones involved with spermatogenesis. However, there are types of protein that can negatively impact on these hormones and their balance. These include, health supplements, such as soy (or soya) based protein shakes, and steroids, such as testosterone. Long term steroid use prevents the hormone responsible for sperm production being released naturally, and therefore, sperm production can cease, and this can often be irreversible. </li><li>Keep your testes cool. Overheating the testes can cause your sperm to suffer from heat shock, which will ultimately cause damage to them, and making them less successful in the fertilisation process. Things such as placing a laptop on your lap can be detrimental to the success of your sperm. </li><li>Quit smoking. By quitting smoking you are able to reduce the amount of “free radicals” (stress) your sperm is exposed to. This prevents potential DNA damage and improves the quality of your sperm, in turn, making them more likely to be successful in fertilisation. </li><li>Drink in moderation Excessive amounts of alcohol consumption can damage the quality of your sperm, which can result in malformed or damaged DNA in fertilisation. Drinking in moderation, or not at all, is very much recommended before undergoing fertility treatment.</li></ol>It must be noted that any changes you make to your diet or daily habits will take at least 3 months to take effect. This is because spermatogenesis (the process of sperm production) takes this long inside the testes. So, if you’d like to make a difference to your chances of conceiving, it might be beneficial to you to begin your preparation sooner rather than later.Have any further questions about how you can prepare for your fertility treatment, please feel free to contact Care.

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Did you know, it is just as important for a man to prepare for IVF as it is for a woman? Having healthy sperm is essential in the success of your fertility treatment as it’s half of the genetic make-up of your baby!

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