Summary: The HFEA Guide To Infertility

infertility
2007/08
FREE

The HFEA guide

Your treatment options explained
Where to find the best support
Questions to ask your doctor

The HFEA guide to Infertility | 2007/08

Welcome needs, you can use the HFEA’s ‘Find a
Clinic’ service on the website at www.hfea.gov.uk. You simply need to enter your postcode, your age or the type of treatment you are interested in, and a list of clinics that match your criteria will appear.
You can check each clinic's performance and read their most recent inspection report. You don't need to give your name or any identifying details and the clinics concerned won't know you have been checking their details so there is no possibility that you will be contacted by any of them.
Because we want to keep you as up to date as possible in what is a fast-moving area of medical science, we constantly update our website with information for patients, so please do visit it regularly. We can also send you paper versions of our publications if you need them.

The chances are that you're reading this because you have been trying for a baby for some time and you're wondering if there is a problem. You may be wondering where you can get reliable, independent information about infertility – what it is, what can be done about it, and what it may mean for you. Will you need medical help, and if so, where should you go to get it?

help you in making one of the most important decisions of your life by providing the best possible information on the different types of treatment that may be available to you.

The Guide has been written by scientific and medical experts with up to the minute knowledge of infertility. But I know from my own experience as a patient representative that hearing from other people who have been through a similar
The good news is that there are many people you can ask, many places you can experience can be very helpful. We are especially grateful to the hundreds of men go to get the answers to your questions. and women who have shared their
The Human Fertilisation and Embryology
Authority (HFEA) has asked some of those experiences with us and told us what they would like to have known before they questions on your behalf, and the started treatment. Their experience is answers – from patients, scientists, doctors and counsellors – make up most reflected in this Guide for you, your partner, your family and your friends. of what is in this Guide.
The HFEA is in a unique position to help you with the information you need. We don't run clinics, we don't provide treatment, but we do regulate, inspect and licence those who do. And one of the things we were set up to do is to provide people considering fertility treatment with independent information. We would like to

If you decide you do want to have medical treatment, choosing a clinic can be a complex decision. Some patients will simply want to go to a clinic near to where they live or work; others may be more interested in the range of treatments provided or the cost. To make it easier for you to find the right clinic to suit your

2 | For further information visit www.hfea.gov.uk

We would like you to help us too, if you can.
You can let us know, in complete confidence, about your own experience at a clinic by completing a questionnaire on the website. And to help us make sure patients' views are kept at the forefront, you can join our online patients' panel Fertility Views
(www.hfea.gov.uk/fertilityviews). Anything that you tell us helps us to make sure that we focus on the issues that matter to you.
And we are always looking for ways to develop and improve this Guide, which we update regularly so do let me know what you found helpful and where you think we could do better, by emailing [e-mail] Whatever decisions you make, I hope this
Guide will help you, and I wish you all the very best for the future.
Shirley Harrison
Chair, HFEA

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Contents
SECTION ONE: BEFORE TREATMENT BEGINS

4

Fertility matters
What it means, how it works and how babies are created

6

Is there a problem?
What could be stopping you starting a family

8

Finding the right help
Who to turn to and what to expect

10

Counting the cost
When is NHS funding available and what are the costs of private treatment?

12

Call the clinic
Finding the right one for you

14

Talking it over
How counselling and support groups can help you at every stage

SECTION TWO: YOUR TREATMENT OPTIONS

16
18
20
22
26
28
29
34
36
38

At the clinic
Drugs and surgery
IUI: Intrauterine Insemination
IVF: In Vitro Fertilisation
ICSI: Intra-Cytoplasmic Sperm Injection
GIFT: Gamete Intra-Fallopian Transfer
Using donated sperm, eggs or embryos
Surrogacy
Freezing and storing embryos
If you become
pregnant
Making the transition from fertility patient to parent-to-be

40

Moving on
Considering your options if treatment has not worked

SECTION THREE: FURTHER INFORMATION

42
44

Clinics licensed by the HFEA
Useful contacts
Groups and organisations that can provide information and support

46
50

Glossary
Ask the clinic
Questions you can ask at your consultation

Disclaimer
Every effort has been made to ensure that information provided in the HFEA Guide to Infertility is accurate as at September 2007, but this cannot be guaranteed absolutely. The information in this Guide does not constitute legal or other professional advice, and is intended to provide general information only. The HFEA cannot vouch for the information supplied by other organisations mentioned in this Guide. Nor does the inclusion of such organisations’ details in the Guide imply any endorsement by the HFEA. Photographs in the Guide are posed by models except for patients’ own stories and those on pages 2, 22, 25, 26 and 39.

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The HFEA guide to Infertility | 2007/08

Fertility matters
IT TAKES JUST ONE SPERM AND ONE EGG TO CREATE A NEW LIFE, BUT THERE’S
MORE TO FERTILITY THAN THAT. WE LOOK AT THE MIRACLE OF MAKING BABIES
Before we start to look at infertility, it helps if you know something about fertility - what it means, how it works and how babies are created. The exact moment of fertilisation is when a woman’s egg and a man’s sperm fuse to form a single cell. But for this to happen successfully, certain things must be in place.
Your hormones, which are your body’s chemical messengers, must be balanced and the bodily systems that produce eggs and sperm must be working at optimum levels. In addition, intercourse must take place around the time of ovulation when an egg has been released from the ovary.

Eggs and sperm
FOR WOMEN
We are all born with a certain number of eggs, but you have to wait until puberty before the hormones that kick-start your menstrual cycle and ovulation come into play.
Successful egg production depends on the interaction of several different hormones. Part of the brain known as the hypothalamus starts off the process by producing gonadotrophin-releasing hormone
(GnRH) which stimulates the small gland at the base of your brain, the pituitary, to release follicle-stimulating hormone (FSH). This in turn triggers the follicles, or egg sacs, to start developing in the ovaries.
These follicles produce oestrogen which stimulates the pituitary gland to produce another hormone called luteinising hormone (LH), the magic body chemical that triggers ovulation once a month until you reach the menopause. The exact time of the month for ovulation depends on your own individual cycle, which in an average 28-day cycle will be around days 12-15, day one being the first day of your period.
At ovulation, the ripest egg sac bursts to release an egg, which starts to

4 | For further information visit www.hfea.gov.uk

travel down the fallopian tube where it may meet a sperm depending on whether you have had intercourse within the last four days. Eggs live and can be fertilised for 12-24 hours after being released and sperm can stay alive and active in your body for
12-48 hours, so you don’t have to have intercourse at the exact moment of ovulation to get pregnant.
After ovulation, the remains of the egg sac form a small yellow body called the corpus luteum, which then starts producing the hormone progesterone whose job is to increase the blood supply to the lining of your womb, making it the perfect environment for a fertilised egg. It takes around five days for the fertilised egg to reach the womb and by the time it embeds itself in the womb lining, it will be made up of around 150 cells.
If the egg isn’t fertilised, or is fertilised but doesn’t attach itself to the lining of the womb, it starts to break down, the corpus luteum shrinks and progesterone levels plummet. As a result, the blood vessels in the womb lining break up, the walls of the womb contract and you have a period, which is in fact the lining of your womb (known as the endometrium) being shed.

FOR MEN
As you reach puberty, the same hormones that control ovulation in women stimulate the release of testosterone, which is responsible for producing sperm.
Gonadotrophin-releasing hormone, or GnRH, produced by the hypothalamus in the brain, triggers the release of follicle-stimulating hormone (FSH) and luteinising hormone (LH) from the pituitary gland.
FSH stimulates sperm production in the testicles while LH stimulates the testicles to produce testosterone.
From the testicles, sperm travel to the epididymis, a 40ft coiled tube, where they mature, which takes between nine and ten weeks. They then travel down another tube, the vas deferens, to the penis ready for their next journey.
At the point of ejaculation during intercourse, your penis releases as many as 300 million sperm into your partner’s vagina but only a few survive the hazardous journey through the neck of the womb (cervix), uterus and fallopian tubes. And ultimately only one will burrow its way into an egg.

2007/08 | The HFEA guide to Infertility

Boost your fertility Here’s what you both can do to increase your chances of getting pregnant as well as lowering the risk of complications during pregnancy.

EAT WELL - A balanced diet will help ensure a woman’s body is healthy enough to conceive and nourish a developing baby. A healthy diet can also help to keep sperm production at optimum levels.
WATCH YOUR WEIGHT - Being overweight or underweight can disturb the menstrual cycle.
TAKING SUPPLEMENTS - The government recommends that all women trying for a baby should take 400mcg of folic acid a day to help protect against conditions such as spina bifida.
DRINK WISELY - Alcohol may affect fertility and increase the risk of miscarriage as well as affecting sperm quality.
Government guidelines advise no more than one to two units once or twice a week for women and two to three for men.
QUIT SMOKING - Smoking has been linked to infertility and early menopause in women and sperm problems in men, as well as being a factor in a premature or low birth-weight babies.
BEWARE DRUGS - Some prescription drugs can lessen your chances of conceiving, so if you are taking regular medication and want to try for a baby, talk to your GP about alternatives. Street drugs such as marijuana and cocaine should obviously be avoided.
BE ACTIVE - Regular, moderate exercise of around 30 minutes a day helps maximise your fitness and keeps your weight in check (see above). It also boosts levels of endorphins, the body’s own happy hormones which may help to get you both through this stressful time.
KEEP IT COOL - For maximum sperm production the testes should be a couple of degrees cooler than the rest of your body. So it may help men to wear loosefitting underwear and trousers and to avoid activities that boost the temperature of the testes such as saunas and hot showers.

Did you know?
Making love less often won’t increase your chances of conception. You are much more likely to get pregnant if you make love every couple of days.

All in a cycle becomes thicker, ready for the possible arrival of a fertilised egg.
Oestrogen also stimulates the mucus produced by your cervix (neck of the womb) which thins it down, making it easier for a sperm to swim through.

FOR WOMEN
The average monthly cycle - the time between periods - is 28 days, day one being the first day of your period. The most fertile time depends on the length of your cycle, which can vary (see below).

Days 15-28: Rising levels of progesterone prepare the womb environment still further for a fertilised egg. If fertilisation has not taken place the hormonal balance changes accordingly and your cycle starts all over again.

But as a general rule:
Days 1-5: You have your period.
Days 6-14: The womb lining starts to build up and, as levels rise,

Ovulation
At puberty, a girl’s body starts to make the hormones that will cause her eggs to mature. Until the menopause, she will release an egg (ovulate) each month, around about day 14 of her monthly cycle (day one is the first day of a period). The average monthly cycle - the time taken between periods - is 28 days, although this differs from woman to woman. Your most fertile time depends on the length of your cycle.
Cycle
length

Fertile days 23 days

7-10

25 days
28 days
31 days
33 days
35 days

9-12
12-15
15-18
17-20
19-22

Talk to a doctor if your cycle is longer or shorter than shown.

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The HFEA guide to Infertility | 2007/08

Is there a problem?
STARTING A FAMILY IS NOT ALWAYS AS SIMPLE AS YOU THINK. READ ON TO
FIND OUT WHAT COULD BE STOPPING YOU
Getting pregnant can be harder than you think. If you are having intercourse regularly without using contraception you should conceive within two years, but in any one month your chances of conception are only around 20 to 30 per cent.
But first some reassurance – if you are having problems conceiving, there is plenty of help available to you, to identify possible causes and how to treat them. You are not alone; around one in seven couples has difficulty.

Infertility is often thought of as a female concern, but in fact in nearly a third of cases
(32 per cent) it is because of male problems, such as a low sperm count. Conditions affecting the woman’s fertility can include damage to the fallopian tubes (16.7 per cent of cases), ovulatory problems (4.9 per cent), endometriosis
(3 per cent) and conditions affecting the uterus
(0.3 per cent). Sometimes it can be a combination of factors that account for infertility
(17 per cent of cases) and sometimes there is simply no identifiable reason (18.7 per cent).

Did you know?
In every 100 couples:

20 will have conceived within one month;
75 will have conceived within six months;
90 will have conceived within a year and
95 will have conceived within two years.

What can go wrong?
FOR MEN
Sometimes a man does not produce enough sperm (known as a low sperm count), or the sperm are not of a sufficiently high quality to fertilise the egg. It is also possible that there are problems with the tubes that carry sperm. If a man finds it difficult to get an erection, or has trouble ejaculating, sperm may not reach his partner’s vagina.

6 | For further information visit www.hfea.gov.uk

FOR WOMEN
Sometimes a woman’s ovaries do not release eggs, or the fallopian tubes can be blocked or damaged, which means that eggs are not carried from the ovaries to the womb. This can also prevent a fertilised egg from reaching the womb, or prevent sperm from reaching and fertilising one of the eggs.

There can also be problems with the womb lining, which mean that a fertilised egg is prevented from implanting successfully. There may not be enough lubricating mucus from the neck of the womb, the consistency of the mucus could be too thick or it could affect the ability of the sperm to swim towards an egg.

2007/08 | The HFEA guide to Infertility

YOU ASK…
I am really stressed at work.
Could this be why I am not getting pregnant?
The jury is still out on this one but some experts think stress could be a factor in infertility and numerous research projects are being carried out in this area. There is no doubt that female hormones are affected by anxiety and tension. Stress is also thought to lower sperm production in some men.

I am 37 and my partner is 40.
Are we too old to have a baby?
Fertility wanes in men and women with age, but the decline is steeper in women. Figures suggest that 94 per cent of women aged 35 years and 77 per cent of women aged 38 years will conceive after three years of trying.
Male fertility is also thought to take a downturn with age, although to what extent is less clear.

I have never had trouble getting pregnant before so why is it taking so long this time?
Regardless of whether you have had a baby or babies with your current or previous partner, you may still find it difficult to conceive. Have there been any major changes in your lifestyle?
For example, have you had any gynaecological or medical problems?
Are you having sex as frequently as you did when you were last trying for a baby? You may also not be as fertile as you were, especially if it is a few years since your last baby.

All about BMI

Beyond the obvious
There may also be underlying factors which are hindering your chances of conceiving. FOR WOMEN
Previous surgery, for example for appendicitis, cancer or an ovarian cyst, may have caused scar tissue, which is blocking your fallopian tubes. Infections such as chlamydia or gonorrhoea can scar the fallopian tubes and prevent sperm from reaching an egg. You may be suffering from polycystic ovary syndrome, which is caused by hormonal imbalances, making ovulation erratic: symptoms include heavy, irregular or absent periods, weight gain, acne and excess body hair. Endometriosis, where tissue

FOR MEN
If you have ever had inflamed testes, usually caused by a virus such as mumps, or drug treatment or radiotherapy, your sperm production may have been affected. Genetic problems are another possible reason for sperm abnormalities. A previous bacterial infection can cause scarring and blockage of the tubes, while surgery, for example to correct

similar to the womb lining grows elsewhere leading to inflammation, pain and scarring, can also damage the fallopian tubes and ovaries.
Other conditions that can have an impact on your fertility include diabetes, epilepsy, thyroid and bowel diseases, as well as gynaecological problems such as a previous ectopic pregnancy or more than one miscarriage. Being overweight or underweight can also affect how easily you conceive. If you have a body mass index (BMI) of over 29 or under 19, for example, you may find it more difficult to get pregnant
(see ‘All about BMI’ below).

a hernia, undescended testes or twisted testicles, can damage the tubes or impair blood flow to the testes. Diabetes, medication or surgery on the urinary tract can cause retrograde ejaculation, when sperm travels backwards. Being overweight can also affect the quality and quantity of sperm. A job that brings you into contact with chemicals or radiation is another factor to consider.

Body Mass Index Graph (courtesy of Cancer Research UK)
© Cancer Research UK www.cancerresearchuk.co.uk

190

The body mass index (BMI) is a measure of your weight in relation to your height.
If your BMI is between 25 and 30, you are classed as overweight, and if it is above 30, you are classed as obese. In both these cases, you may find it harder to conceive. Some clinics may take your
BMI into account when deciding if you are eligible for treatment. Use this chart as a guide to your BMI range by finding the point where your weight (going across) meets your height (going up).

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The HFEA guide to Infertility | 2007/08

Finding the right help
IF THE MONTHS GO BY AND YOU STILL HAVEN’T CONCEIVED,
IT COULD BE TIME FOR A CHAT WITH YOUR GP
If you are both young and healthy and have been trying for a baby for 18 months to two years without success, a visit to your doctor could help to highlight potential problems earlier rather than later. But if you

are over 35, it is a good idea to make an appointment with your GP after six months, as fertility tests can take time to complete and your age may affect the treatments available to you.

Ask your GP

In the surgery
Your GP will listen to your concerns, make a note of your medical history and give you a physical examination. This is usually followed by a few basic tests, which can include:

Why am I being offered the test?
Are there any alternatives?
What will the test show?
How long will the test take?

FOR WOMEN
Cervical smear test if you haven’t had one recently.
Urine test for chlamydia, which can block your fallopian tubes, preventing you becoming pregnant.
Blood test to see if you are ovulating.
This is done seven days before your period is due.

When can I expect the results?
Blood test to check for German measles (rubella) which, if contracted during the first three months of pregnancy, can harm your unborn baby.
Blood test during your period to check for hormone imbalances.

FOR MEN
Sperm test to check for abnormalities. 8 | For further information visit www.hfea.gov.uk

Urine test for chlamydia.

Going forward
If your test results are normal and you have been trying for a baby for less than
18 months your GP may suggest you make a few lifestyle changes (see page
5) and go on trying for a bit longer. If, however, the tests reveal a possible fertility issue, especially if you are in your thirties or older, they may make an appointment for you to see a specialist at your local hospital or fertility unit. Some fertility treatments are available on the
NHS and your GP should be able to tell you what these are. The private sector also provides a full range of services.

2007/08 | The HFEA guide to Infertility

Your GP should refer you for further tests without delay if:

FOR WOMEN
Your monthly cycle is less than 21 days or longer than 35 days.

Ask your GP

FOR MEN
Your sperm test shows abnormalities.

Do you refer patients to a particular clinic or specialist and if so why?

You’re not ovulating.
You have had previous gynaecological conditions such as endometriosis, an ectopic pregnancy or a pelvic infection.
You are in your thirties and have been trying for a baby for over 18 months. What clinics and treatments are available locally?

FOR MEN &
FOR WOMEN

What kind of a clinic is it and what treatments does it offer?
How long will we have to wait for an appointment and is there anything we can do to speed things up?

You have abnormally shaped pelvic organs.

If we need fertility drugs and tests can we get them on the NHS or will we have to pay?

You have been trying for a baby for three years or more.

At the clinic
Further tests at your local hospital or fertility clinic may include:

FOR WOMEN
Blood tests to find out if you are ovulating.

and a flexible tube with a tiny camera attached is used to check for tubal blockage.

FOR MEN

Ultrasound scan to look at your womb and ovaries.

Hysteroscopy – a telescope with a camera attached is used to view your uterus to check for conditions such as fibroids or polyps.

Follicle tracking – a series of ultrasound scans follow the development of a follicle to see if an egg is developing.

Hysterosalpingo-contrast sonography
(HyCoSy) – a vaginal ultrasound probe is used to check the fallopian tubes for blockages.

Hysterosalpingogram – an x-ray to check your fallopian tubes.

Occasionally, a tissue sample may be taken from your womb lining to be analysed.

Semen analysis to check sperm numbers and quality.
Sperm antibody test to check for protein molecules that may prevent sperm from fertilising an egg.
Sperm invasion test to see if sperm are swimming through the cervical mucus and are still active.

Busting the jargon

Laparoscopy – an operation in which a dye is injected through your cervix

INFERTILITY - means you are unable to conceive.
SUBFERTILITY - which is more common, means you have problems that make conception difficult if not highly unlikely without medical help.
This term is also used if you can get pregnant but keep having miscarriages. Talking it over
It can be difficult to appreciate just how stressful infertility can be unless you have been through it yourself and you may find your family and friends are not as understanding as you would like them to be. To help you through what many couples describe as ‘this emotional rollercoaster’ you may find it helpful to join a support group where you can meet other couples who are

going through the same experience.
Ask your GP for details of any local groups or see page 44.
You will also find a lot of internet support sites run by people who have similar experiences. You may also find it helpful to talk to a counsellor who specialises in helping those with fertility problems
(see page 14).

PRIMARY INFERTILITY - is the term used for couples who can’t conceive.
SECONDARY INFERTILITY - refers to couples who, after having had one or more babies, can’t conceive or who have had one or more miscarriages or stillborn babies. Secondary infertility is more common than primary infertility.

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The HFEA guide to Infertility | 2007/08

Counting the cost
WHEN ALL YOU WANT IS A BABY NO PRICE CAN SEEM TOO HIGH, BUT BEFORE
STARTING TREATMENT YOU DO NEED TO THINK ABOUT THE FINANCIAL SIDE
You can either have NHS-funded treatment or go privately.
The treatment won’t necessarily be any better in the private sector, but you can probably start treatment more quickly, although there may still be waiting lists for treatments such as egg donation.

NHS-funded treatment Provision of NHS-funded treatment can still vary across the UK but the NHS aims to offer women between the ages of 23 and 39 at least one free cycle of IVF, assuming you meet the eligibility criteria.
Some criteria are set out in the National
Institute for Clinical Excellence (NICE) fertility guideline (see www.nice.org.uk) and others are determined locally, such

as the treatment of couples where one partner already has a child. The NICE guideline applies to England and Wales only - Scotland and Northern Ireland have different criteria. For the most up to date information, talk to your GP.
NHS treatment may be available at your local hospital or a private clinic if your
Primary Care Trust or Health Board has a contract with them. Waiting lists vary.
Unless you are exempt, you will have to pay prescription charges for drugs.
Possible restrictions
If initial tests show up no identifiable cause for your infertility you may be offered tests and other treatments, such as fertility drugs and intrauterine insemination, before being offered IVF.
Women must be under 40 and, after clinical assessment, be thought to have a good chance of responding positively to treatment. For example, they should not be coming up to the menopause. Going private
In theory, anyone with the means can have private treatment, but individual clinics still have rules about whom they will and won’t treat. We recommend you ask the clinic about their eligibility criteria early on.
So what’s involved if you go privately?
You pay for your drugs and treatment at a private unit of your choice and you get to choose your consultant. Treatment prices can vary widely from clinic to clinic depending on what tests and treatment you are offered. Treatment costs also vary significantly according to an individual’s medical circumstances. A single attempt at donor insemination can typically cost between £500 and £1000.
A cycle of IVF, including drugs and

consultations, can typically cost between
£4,000 and £8,000. This will depend on where you live and the clinic you choose though the final cost may be more or less than this. If you need ICSI or donor eggs or sperm then your treatment will usually cost more than standard IVF.
That said, private clinics are in competition with each other and prices tend to be fairly similar. The drugs used for IVF are expensive, so check if they are included in the overall price. If they aren’t, it’s worth comparing prices from different sources such as your clinic’s dispensary and local pharmacies, as prices can vary.
Sometimes they may be available direct from the pharmaceutical company.
Some fertility clinics offer egg-sharing schemes in which women can donate eggs collected from a cycle of IVF to another woman in return for a reduced

10 | For further information visit www.hfea.gov.uk

There may be criteria relating to existing children.
The Choice of Referral scheme, which came into effect from
1 January 2006, gives most patients some choice of where they are seen when they are first referred by their
GP for an outpatient appointment.
This will include couples who are being referred to a specialist for tests to determine the cause of infertility.
However, patients’ right to choose under the scheme does not extend beyond the first outpatient referral.

Are you eligible? To find out if you are eligible for
NHS funding, the first person to speak to is your GP, as you will usually need a referral from them.
Alternatively, you can contact your
Primary Care Trust (England), Local
Health Board (Wales), Health Board
(Scotland) or Health and Social
Services Board (Northern Ireland) direct, and ask for details about their funding policy, and who is eligible.

price IVF treatment. They will still have to pay for any extra treatment needed.
Both NHS and private clinics pay a fee towards the costs of being regulated by the HFEA. Regulation is needed to ensure the clinics comply with the law and that practice is safe and appropriate.
The fee paid by clinics to the HFEA is based on the number of IVF and donor insemination treatments they carry out.
We charge the clinic directly and some include this in their overall fee to patients, as they do for the other costs of running a clinic. Some clinics, however, may pass this cost directly on to you as an additional cost: £104.50 for each IVF cycle or £52 for each donor insemination cycle. Do check with your clinic what their practice is.
For more information visit www.hfea.gov.uk/ForPatients 2007/08 | The HFEA guide to Infertility

How it adds up
Costs typically cover:
First and follow-up consultation appointments for a couple.
Simple tests such as hormone tests, ultrasound scans and sperm tests.

Special tests such as hysterosalpingogram (fallopian tubes x-ray), ultrasound tracking of egg development, trial embryo transfer and genetic tests.

donor insemination, IVF, ICSI, egg or sperm donation or frozen embryo donation.
Freezing and storage of sperm and embryos.

Assisted conception treatments, including intrauterine insemination,

Our story: We were treated on the NHS

Sara, 34, a civilian in the police force, has polycystic ovary syndrome
(PCOS) and her husband Kevin, 40, a police officer, has a variable sperm count. After treatment the couple, who live in the Midlands, are expecting their first baby. Sara tells their story:
Treatment time
‘We were treated on the NHS and only had to pay an extra £270 to have our embryos frozen. We had no problems

getting NHS treatment as I’m under 38 and have no children. We couldn’t have had treatment if we had not been eligible because we were not prepared to bankrupt ourselves for a baby. I took fertility drugs and was offered several other treatments before being offered
IVF. Our first two attempts failed but on the third attempt we used ICSI as well and I conceived.’
Feelings
‘We’ve been open right from the start and friends and family have been very supportive. Several couples at work have approached us for help and advice.
You feel different but we have joined a support group which has helped.’
Our relationship
‘On the whole it hasn’t affected our relationship. As we have been so open

with everyone else we don’t feel we have to talk about it with each other all the time and so far we have been alright.’
Our tips
Find out what you can about your options. We knew little when we started and sometimes I feel we don’t know very much as there are always new things coming out. I have tried to look up things but until you are lying there you don’t know what’s going to happen or how it will affect you.
Keep a sense of perspective. At the end of the day it’s not the end of the world if it doesn’t work.
Get support. There’s nothing to be ashamed of. Just because you can’t conceive you are not a freak.

Our story: There are long waiting lists in our area
£1,200, we were offered IVF. While we were waiting I conceived naturally but miscarried. We then tried again, which cost £3,000, but our eggs and sperm did not fertilise. Then we tried IVF with ICSI twice costing £9,000. On the second attempt I conceived.’

Helena, 34, a business management consultant, and her husband Ian, 34, a surveyor, had private fertility treatment. They live in London and now have a daughter, Sienna, who is a year old. Helena tells their story:

Feelings
‘I felt incredibly optimistic, although the worst time was after the miscarriage.
The clinic gave me a huge amount of confidence and each time we started a new treatment cycle we felt good because we were doing something.
Friends and family were really supportive but devastated when it didn’t work.’

Treatment time
‘There are long waiting lists for fertility treatment in our area and we didn’t meet the criteria so we chose a private clinic.
After monitoring three cycles, which cost

Our relationship
‘Working through the many different treatments together and all the ups and downs that came with them brought us closer as a couple.’

Our tips
Choose your clinic carefully. It’s vital that the ‘fit’ between you and your clinic feels right. We looked at a couple before settling on the one we went to.
Take care of yourself. I decided I would try some anti-stress therapies including acupuncture.
A positive pregnancy test doesn’t mean you will have a baby. Because of my miscarriage I felt really stressed out for the first 12 weeks of my pregnancy half expecting it to be snatched away again.
It’s okay to have a bad day. Your baby is no different to any other so don’t feel guilty if you feel tired and exasperated with your crying baby.

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The HFEA guide to Infertility | 2007/08

Call the clinic
WITH SO MANY ASSISTED CONCEPTION CLINICS, YOU MAY HAVE
TO SHOP AROUND BEFORE FINDING THE RIGHT ONE FOR YOU
There are about 128 HFEA-licensed clinics in the UK so it’s not surprising you may find the choice overwhelming. It’s worth spending some time exploring all your options so that when you do make your final decision you feel comfortable with it.
A good starting place is to find out if you are eligible for NHS treatment, or whether you will have to go privately (see page 10), as this may affect your choice of clinic – around a quarter of clinics take private patients only.
If you are having NHS-funded treatment, find out if you can have a say in the choice of clinic (some private clinics take NHS patients if there is a suitable contract with the relevant health authority). If not, ask your GP why you

Location, location, location The first thing to consider is where the clinic is. Getting up in the middle of the night and trekking half way across the country to have eggs collected or to give a sperm sample can be stressful, which is exactly what you don’t want at this already anxious time. Taking time off from work for consultations and treatment may also be tricky. So it may be worth choosing a clinic that’s within easy travelling distance.

have been referred to a certain clinic and also if there will be any costs to you (see page 10 for more about costs and page 42 for a list of clinics).
You can use the HFEA website’s interactive clinic search facility (see HFEA ‘Find a clinic’, opposite) to draw up a shortlist of possible clinics who you can then contact. This will help you to compare what each one offers, including prices if you are going privately. You might then want to arrange to visit a few so you can get a feel for the place.
Making a final decision can be exhausting and confusing, so here are a few pointers to help you on your way.

First appearances
Do your homework and find out as much as you can about the clinic. Some may have special interests and expertise in specific treatments.
You may feel drawn to older establishments with a tried and tested reputation, but don’t dismiss new clinics, which may offer equally high standards of treatment. If you do opt for a clinic that is further away you may be able to have certain treatments carried out at a local hospital
(referred to as a satellite or transport centre). When making initial enquiries take into account the attitude of the person at the other end of the phone. For example, are they sympathetic to your questions?
It is very important that you are made to feel involved in the decision making rather than just feeling as if you are on a conveyor belt.

Think about
How far away is the clinic from home or work?
How easy is it to get to?
Is there public transport or a car park?
Are there any treatment arrangements with a more local hospital?

Of course you may have doubts as to whether you are making the right choice.
One of the best ways to allay them is by talking to other patients. No one can possibly say that such and such a clinic is the best one for you but they can share their personal experiences (see page 44).

12 | For further information visit www.hfea.gov.uk

Think about
Will you see the same doctor or nurse every time?
Can you choose between a male and a female doctor and nurse?
What provisions are there for the protection of your privacy and dignity in the clinic?
Do the staff sound welcoming and proud of their work?
Can the clinic put you in touch with other patients?

Support lines
Rest assured, all clinics offering IVF and other treatments will give you the chance to talk over your treatment and any worries you may have with a counsellor.
There are usually several different types of counselling available (see page 14).
Think about
What types of counselling or support groups does the clinic offer?
Are these services free or will we have to pay extra?
Does the clinic offer patient support groups?

2007/08 | The HFEA guide to Infertility

Rules and regulations Does the clinic have any selection criteria for patients? For example, do they only take couples under a certain age, and are single women and same sex couples welcome? And maybe it has a cancellation policy if too many or too few eggs are produced as a result of taking fertility drugs as well as time restrictions on different treatments.

also worth looking at the clinic’s multiple birth rate. A high multiple birth rate may account for a clinic’s high live birth rate but multiple births carry a greater risk to both mother and babies. See the HFEA
‘Find a clinic’ search, below, to help you evaluate the success rate of a clinic.

Any restrictions such as age or sexual orientation. How many cycles of treatment are allowed before trying another or stopping treatment all together.

Success rate
There’s not a clinic in the world that can promise you will go home with a baby but it is important not to choose a clinic just because its success rate looks good on paper. Success rates, or live birth rates as they are called, are incredibly difficult to interpret. For example, a clinic that accepts only younger couples with straightforward infertility issues will usually have better success rates than a clinic that takes older couples or couples who need more complicated treatment. It’s

What kind of questions will the clinic ask about my circumstances? By law, before you start treatment, your clinic must consider both your potential baby’s welfare (including
“the need for a father” specifically mentioned in the 1990 Human
Fertilisation and Embryology Act) and how the birth may affect any other children you may have. The assessment is designed to foresee any circumstances in which your potential baby might experience serious harm.
The clinic will ask you some questions about your medical and social history, for example, whether you have had any contact with social services over the care of any children you may already have. Cases in which serious harm is likely are very rare, so most people can start treatment without delay. Occasionally, with your consent, a clinic may want to make further enquiries to relevant individuals or agencies such as a GP or social services. Policies about treating single women, same sex couples and older women vary from clinic to clinic. Clinics will often apply an upper age limit for the women they will treat, although none is set by the HFEA or the law.
The HFEA has recently revised its guidelines to clinics on this issue.
For more information, see www.hfea.gov.uk/ForPatients Think about
The live birth rate for the type of treatment you are having.
The life birth rate for your particular age group.

Think about
The length of the waiting time.

YOU ASK…

Embryo transfer policy Clinics can replace two embryos at each IVF attempt, or three if you are aged 40 or over (and using your own eggs). Replacing more would increase your chance of having a multiple pregnancy, with its associated health risks. Some doctors prefer to replace one embryo to reduce this risk, and freeze any remaining embryos to be used in the future, if the treatment is unsuccessful. Think about
What is the rate of multiple births for the clinic, and how do you feel about this?
What are the clinic’s criteria for freezing embryos?

HFEA ‘Find a clinic’ search
A good way to find a list of licensed clinics in your area with details of their services and success rates is to use the ‘Find a clinic’ search on the HFEA website (www.hfea.gov.uk)

Here’s how it works:

1
2

Start by entering your postcode or region, your age band, type of treatment you are considering (if you know it) and whether you are an
NHS or private patient. If you don’t know yet, you can enter both.
The locator will bring up a list of clinics that meet your criteria, so you can see how many people in

your age group have received that treatment and for how many it has been successful. The number of treatments carried out can be a good indicator of the level of experience of the clinic.

3

To find out more about the clinic, click on the most recent HFEA inspection report. Inspections are carried out at regular intervals and the reports will give you the most up to date information.

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The HFEA guide to Infertility | 2007/08

Talking it over
THE GOING CAN BE TOUGH, BUT THERE IS SOMEONE AT EVERY STAGE TO HELP
We all have times when we need someone to talk to who will really listen. You and your partner may be finding it hard to deal with your diagnosis of infertility, feeling unsure about what all the language and jargon mean, or wondering how you will ever cope with all the tests and treatment. This is where a counsellor can help.
Friends and family may be supportive, but it is often useful to talk about your feelings with someone who doesn’t know you and who will not judge what you say or are feeling from a subjective point of view. Counselling can help you explore your feelings, become clearer about your situation and find new ways of coping.

Considering the implications All HFEA-licensed clinics have to offer access to implications counselling before you consent to treatment. This involves a counsellor talking to you about the treatment you are having or plan to have, so that you understand exactly what it involves and how it might affect you and those close to you - now and in the future.
This is especially important if you are considering treatment with donated sperm, eggs or embryos or surrogacy arrangements - all of which involve complicated issues. You will need time to explore how you feel, to adjust to this different way of planning a family, to consider the legal implications and decide if this is going to be the right decision for you. Spending time with a counsellor can help with this and enable you to feel better prepared for parenthood through donation or surrogacy.

Facing up to feelings If you need emotional support before, during or after fertility treatment, support counselling is available at many clinics. You can ask for written information and if you need additional support, your clinic will have information about other services in your area.

This form of counselling is especially useful in helping you to work through the emotions you may experience at specific times during treatment, such as when you first find out you have fertility problems, when you are waiting for results, if you are faced with a negative outcome, or if you are both having to come to terms with the fact that there is no further suitable treatment for you to try.

Dealing with the past
Infertility can throw up all sorts of issues.
For example, it can sometimes trigger painful memories from your past or the treatment may be making you depressed or anxious. Therapeutic counselling shows you how to work through some of these difficult issues to great effect. It can really help you to deal with the impact that infertility may be having on your life and your relationships with other people.
Ask the doctor or specialist fertility nurse for information. If it is not available at your clinic, they can refer you to an independent counsellor elsewhere.

Making contact
Your clinic should provide you with the contact details of a counsellor. Different clinics have different costing policies, so check whether you have to pay extra for counselling. You may choose to have just one or two sessions or more, as and when you feel you need them.

14 | For further information visit www.hfea.gov.uk

They usually last for an hour and you can expect to see the same counsellor each session.
If for any reason you don’t feel happy or comfortable with your counsellor, talk to them about what’s worrying you. If you feel you still can’t communicate, ask to be referred to another counsellor.

WHAT COUNSELLING
CAN GIVE YOU...

1

The opportunity to talk freely and openly without being judged.

2

The chance to explore feelings and sensitive issues that are troubling you.

3

Help in understanding the factors that may be contributing to your difficulties. 4

Support in finding your own solutions and new ways of coping.

5

The knowledge that what you share with your counsellor will be treated as confidential unless there are exceptional circumstances.

For information on counselling organisations and other forms of patient support, see page 44.

2007/08 | The HFEA guide to Infertility

YOU ASK…
Since we started trying for a baby, sex has become much less fun. What can we do?
Couples with fertility issues often find their love life suffers. Intercourse becomes much more about making a baby rather than about fun and showing your feelings for each other.
If you feel this is affecting your relationship a skilled counsellor can help you to explore the difficulties as well as working with you to resolve them.

My friend has just had a baby and I can’t bring myself to tell her that we are finding it hard to start a family. What can I say?
Deciding whether and what to tell family and friends can be hard. You need to think about who you are going to tell and what you are going to say. If you do decide to confide in someone it may help to explain to them exactly how they can support you. You may want to talk this through with your counsellor to consider all the possible issues.

The expert says...
‘We’re based in the IVF Unit and see over
300 people a year for counselling. Some come for just one or two sessions while others need many more. They may want to come on their own or as a couple.
‘Some of our work involves helping people to talk about their experiences and to understand the underlying issues which makes it easier for them to find ways to cope or sort out problems.
‘It’s not surprising that infertility affects the rest of people’s lives. It’s pretty hard to face friends with children, or to deal with talk at work about families or with someone going on maternity leave.
Within a relationship, too, infertility can cause a huge amount of stress.
‘We offer people a safe space where they can focus on their problems and be supported in finding their own solutions.
Often, just sharing feelings with someone outside their circle of friends and relations brings a sense of relief.
‘There are certain key times which can be particularly difficult. At the start of a first treatment cycle, people are often anxious and uncertain about what to expect.

‘During treatment they often say it is an emotional rollercoaster as they wait and see if they produce enough eggs, if they fertilise, and how many embryos are created. If people have had any problems with any of these issues in a previous treatment it will be especially stressful.
‘Then, after the embryos are transferred there is the long, anxious wait for results. The day of the pregnancy test is usually very tense.
‘Many of our patients see counselling as a useful way of preparing for treatment – as an extra source of support and stress management during it. It can be especially important for those faced with a negative pregnancy test or if there are problems with the pregnancy itself.
‘A skilled counsellor can play a vital role in enabling couples to deal with the emotional challenges of these difficult experiences.’

Jennifer Hunt
Senior Infertility Counsellor
Hammersmith Hospital

Our story: Ask about support or counselling options onto IVF on the recommendation of our consultant and on the fourth attempt I conceived Adelaide.’

Caroline, 35, and her husband
Andrew, 36, a farmer, live near
Sevenoaks, and have unexplained infertility. Their daughter, Adelaide, who is now four, was born after IVF.
Caroline tells their story:
Treatment time
‘I was on Clomid for six months and then had three attempts at IUI, none of which was successful. We then went

worked through it giving each other support. In many ways it brought us closer together.’

Feelings
‘To start with we felt a bit unsure and the idea of having to have IVF took getting used to. We were hit quite hard emotionally. I thought it was going to work first time so it was a shock when it didn’t. Those friends and family we did tell were extremely supportive. However we didn’t tell a lot of people because we felt it was quite private.’

Our tips
Ask at your clinic about support or counselling options. Support is absolutely vital because infertility treatment can be such a solitary experience. No one in the waiting room ever talks to each other.

Our relationship
‘When you are trying for a baby it takes all the spontaneity out of sex so it is quite a strain. We would get quite excited when having the embryos replaced and then feel utterly despondent when it didn’t work. But we

Set up a group if there isn’t one. The consultant set up a first meeting of a support group and invited us along.
After that a group of us carried on organising monthly meetings. It was invaluable to get together and chat with like-minded people who were going through the same thing. We made some very good friends through it who we still have today.

For further information visit www.hfea.gov.uk | 15

The HFEA guide to Infertility | 2007/08

At the clinic
WHEN AT LAST YOU GET TO THE CLINIC, THE CHOICE OF TREATMENTS ON
OFFER CAN BE BEWILDERING. MOST PEOPLE HAVE HEARD OF IVF, BUT THERE
ARE OTHER TREATMENTS TOO. THIS SECTION WILL TELL YOU MORE ABOUT
THEM, WHAT THEY INVOLVE AND WHETHER THEY COULD BE FOR YOU
Many people tell us that they feel a bit swept along by the process when they go to a clinic.
It’s important to feel that you are getting the most out of your consultations, and feel comfortable asking questions, or taking time out to think things through. There can be a lot of difficult issues to consider, as this section will show: decisions such as what to do with embryos not used for your treatment, or how to tell your child that they were conceived using donated eggs or sperm. Do remember that the clinic staff are there to help you make the right choice for you.
Even with understanding family and friends, you can feel isolated while you are having fertility treatment. That’s why, throughout this section, we’ve asked people to share their experience of treatment with you and to offer advice on what they learnt.
As well as thinking about treatment and the surrounding issues, you’ll also find there’s quite

16 | For further information visit www.hfea.gov.uk

a lot of paperwork involved. This is because the clinic needs to make sure that you understand, and agree to, all that is involved in having treatment (see opposite).
Every patient longs for the moment when a pregnancy is confirmed. But some people find they have been so focused on treatment that they don’t feel prepared for the actual pregnancy.
There’s more information on what to expect in this section.
Sadly, although treatment is becoming more successful, this is not everyone’s experience.
This section also looks at what to do if your treatment has not worked.
Finally, whatever the outcome of your treatment, we hope that you feel that your clinic has looked after you well throughout, both physically and emotionally. But if you are unhappy with your clinic, this section will provide suggestions for how to make a complaint.

2007/08 | The HFEA guide to Infertility

Giving your consent As with most medical procedures, you and your partner, if you have one, will have to give your consent to treatment.
You may wonder why there can be so many forms to fill in before treatment can even start but this is necessary to protect you and any child you may have. Fertility treatment is still relatively new and there are many ethical issues to consider.
The HFEA provides clinics with consent forms for different treatment options and you and your partner will have to sign the ones relevant to your circumstances. For your consent to stand, it must be written and it must be current (ie. you have not subsequently withdrawn it).
It is important that you fully understand the implications of the treatment to which you are giving your consent. Your clinic will offer you the opportunity to have professional counselling, which many people find helpful. Your clinic must also provide information about the procedures and processes involved in your treatment.
There is no hurry, so do ask questions and make sure you understand this and take your time to reflect on it before you sign anything.
There are three different types of consent:
1. CONSENT TO:
Your fertility treatment
Basically this is no different to the form you have to sign for many other medical treatments. For example, if you are having IVF you will have to consent to egg retrieval and the transfer of embryos into your womb. Similarly, you will have to give consent if your treatment involves donated eggs, sperm or embryo transfer (see 3).
2. CONSENT TO:
Disclosure of information
Your clinic is not allowed to tell your GP or anyone else about your treatment unless they have your consent to do so.
It is up to you to decide what information you allow to be disclosed and to whom.

YOU ASK…

3. CONSENT TO:
The use and storage of eggs, sperm and /or any embryos produced from them
The use could be for your own treatment, for the treatment of others if you are donating sperm, eggs or embryos, or for research. Storage relates to the freezing of sperm, eggs or embryos for future use.

Can a man be registered as the father of a child conceived after his death?

As long as your eggs, sperm or embryos have not already been used in treatment or research, you can change or withdraw your consent by getting in touch with the clinic where they are being stored. Your partner or, if a donor was used, then the donor, may also change or withdraw consent at any time until the eggs,

Although rare, there are situations when a woman may want to have a child with her husband or partner, which is conceived after his death. For example, he may have had sperm stored prior to cancer treatment. A man can be recorded as the father of a child resulting from fertility treatment carried out after his death, as long as his consent is there in writing.

Licence to…
Fertility treatment is strictly regulated by law to protect you and your family. Under the Human Fertilisation and Embryology
Act 1990, any treatment which involves mixing sperm and eggs outside the body, or using eggs, sperm or embryos, has to have an HFEA licence.
It is illegal to create an embryo outside the body or to keep or use an embryo without an HFEA licence.

sperm or embryos have been used in treatment. If consent is withdrawn by either party or a donor, the eggs, sperm or embryos may not be kept in storage or used in treatment.
You must also state what you would like to happen to these eggs, sperm or embryos if you were to die or become mentally incapacitated and therefore incapable of changing or withdrawing your consent.
It is important to keep in touch with your clinic. They will contact you six months before any eggs, sperm or embryos reach the end of their storage period, so it is vital that you let them know if your contact details change. If your storage period limit is up, the clinic is obliged by law to allow any eggs, sperm or embryos to perish, even if they have not been able to trace you first. If they do not comply with this, they risk losing their HFEA licence.

In practice, this means that clinics need an HFEA licence to provide: in vitro fertilisation (IVF) donor insemination (DI) intra-cytoplasmic sperm injection
(ICSI)
intrauterine insemination (IUI) with partner and donor sperm gamete intra-fallopian transfer (GIFT) with donor/partner sperm and eggs any treatment using donated eggs, sperm or embryos sperm, egg and embryo freezing and storage pre-implantation genetic diagnosis (PGD) pre-implantation genetic screening for aneuploidy (PGS)
Clinics carrying out the above treatments are regularly inspected by the HFEA. To find out more about the HFEA, how we regulate fertility treatment in the UK, and how you can provide feedback on your experience of treatment, visit www.hfea.gov.uk For more information about embryo storage, see page 36 and www.hfea.gov.uk/ForPatients For further information visit www.hfea.gov.uk | 17

The HFEA guide to Infertility | 2007/08

Drugs and surgery
A COMBINATION OF FERTILITY DRUGS AND SURGERY ARE OFTEN USED
TO KICK-START TREATMENT EITHER BEFORE OR DURING IVF

FOR WOMEN
If you aren’t ovulating (producing and releasing an egg each month) at all, or only sometimes, fertility drugs - which trigger egg production in much the same way as your body’s own hormones - can help. This is known as ovulation induction.
You may get pregnant using fertility drugs alone, but they are more often used with other treatments such as intrauterine insemination (IUI) and in vitro fertilisation
(IVF). Read on for what to expect.
Ovulation-inducing drugs
Clomiphene citrate, usually known simply as Clomid, is the oldest and probably the most widely used fertility drug. Taken as a pill, it tells your brain that you are not producing enough oestrogen, which indirectly stimulates your ovaries into producing eggs.
What for Straightforward ovulation failure in women under 40.

Possible side effects Hot flushes, mood swings, nausea, breast tenderness, insomnia, increased urination, heavy periods, spot breakouts, weight gain. Some experts think your risk of ovarian cancer may increase slightly if you take it for more than a year.
Pituitary stimulators
Pulsed gonadotrophin-releasing hormone (GnRH), such as Gonadorelin, kick-starts the pituitary gland into action.
A small battery-operated pump usually worn on your upper arm injects pulses of the drug directly into your bloodstream (hence the term ‘pulsed’).
This triggers egg production by mimicking your body’s production of a hormone produced by the pituitary.
What for Ovulation failure resulting from a lack of the hormone GnRH.
Possible side effects Stomach pains, sickness and nausea, heavy periods and headaches. Ovary-stimulating hormones
Drugs containing follicle-stimulating hormone (FSH) and/or luteinising hormone (LH) stimulate the ovaries to produce eggs. These include Gonal-f,
Puregon, Menogon, Menopur and
Merional. They are injected into a muscle or under the skin by your doctor at the clinic, your GP or practice nurse.
Alternatively, you may be shown how to inject yourself at home. When the eggs are mature, you are given a single injection of the hormone human chorionic gonadotrophin (hCG) to trigger the release of an egg.
What for To stimulate ovulation before treatment cycles, or if you have polycystic ovary syndrome (PCOS) and your ovaries are not responding to
Clomid. They are also used for infertility caused by failure of the pituitary gland and in some cases of male infertility.
Possible side effects Over-stimulation of the ovaries, known as ovarian hyperstimulation syndrome (OHSS, see page
24); increased risk of multiple pregnancy
(twins, triplets or more) when used for ovulation induction, allergic reactions and skin reactions.
During treatment, your doctor will usually prescribe other drugs for you to take at various times to give them more control over your treatment cycle. These may include:
Cycle-suppressing drugs
Drugs such as Goserelin and Burserelin copy the action of natural hormones that block the release of the two hormones controlling ovulation: FSH and
LH. These are known as gonadotrophinreleasing hormone (GnRH) analogues.
You take them as a nasal spray or as a daily or monthly injection before, or at the same time as, fertility drugs.
What for To stop the menstrual cycle.
Possible side effects Hot flushes, night sweats, headaches, vaginal dryness, mood swings, changes in breast size, breakouts of spots, acne and sore muscles.

18 | For further information visit www.hfea.gov.uk

2007/08 | The HFEA guide to Infertility

Surgical options
Drugs that maintain pregnancy
Progesterone, for example Cyclogest,
Gestone, Crinone or Progynova, can be taken after the injection of the pregnancy hormone, hCG, or on the day embryos are returned to the womb. You take them as a vaginal suppository, a pill, gel or by injection into the buttock.
What for To thicken the lining of the womb in preparation for nurturing a possible embryo.
Possible side effects Nausea, vomiting, swollen breasts.

FOR MEN
Drugs are not so important in the treatment of male infertility as they are in female treatment.
However they may occasionally be prescribed in certain situations.
These may include:
Antibiotics to treat infection or inflammation Vitamins C and E to improve sperm movement, although there is no convincing evidence that this improves the chance of pregnancy
Gonadotrophin injections or pump administration for certain rare conditions in which no sperm is produced Drugs that close the bladder neck when sperm are being ejaculated into the bladder instead of the penis
(retrograde ejaculation)

YOU ASK…
Is the chance of having twins or triplets higher if you are taking fertility drugs?

FOR WOMEN

FOR MEN

My tubes are blocked because of chlamydia.
I have heard that an operation might help.

I have had a vasectomy but my partner and I now realise we would like to have another baby.
Is it too late?

Surgery used to be popular when IVF and ICSI treatments were less advanced and available, but an operation can still help in some cases. Blocked tubes, caused by inflammation and scarring as a result of infections such as chlamydia, for example. Others include fibroids, endometriosis and other conditions affecting the womb or tubes.

If you can’t produce any sperm, for example, you may have had a vasectomy or a failed reversal, a small operation known as surgical sperm retrieval can be carried out to remove the sperm from the epididymis (where sperm are made) or the testicles.

These days, keyhole surgery is most often used. Your doctor at the fertility clinic will be able to advise on whether surgery is the best route for you and also if it is available on the
NHS.

I was sterilised two years ago as I thought I didn’t want more children. But now I have a new partner and we want to try for a baby. Can my tubes be repaired? You can have an operation to rejoin the ends of the fallopian tubes.
Success rates are higher if you were sterilised quite recently and if the tubes were clipped rather than tied.
Keyhole sterilisation reversal
(laparoscopic anastomosis) can also be done but is generally less successful than open surgery.
Instead of the 10cm bikini line cut involved in traditional sterilisation reversal surgery, the surgeon makes a 1cm cut near your belly button through which a laparoscope (small telescope with camera attached) is inserted to allow the surgeon to rejoin the tubes.

The injected drugs used to stimulate ovulation do increase your chances of a multiple pregnancy and birth: twins, triplets or more. If you are taking fertility drugs with IUI, many doctors will cancel a cycle in which you produce a large

PESA (percutaneous epididymal sperm aspiration) involves guiding a small needle through the skin into the epididymis to draw out a small amount of fluid containing sperm.
TESE (testicular sperm extraction) uses the same method to remove a small amount of tissue from the testes. MESA (microsurgical sperm aspiration) uses a small needle to extract relatively mature sperm from the epididymis. The collected sperm can be used to fertilise the eggs by means of ICSI (see page 26).

Is treatment for varicocele a possible cure for male infertility?
Probably not. Until recently, it was thought that treating a varicocele
(varicose vein of the testicles) in an infertile man would increase the chance of becoming fertile again.
Studies have shown that after treatment, the sperm count and quality often improve. This was assumed to increase the chance of fertility. However, a recent large analysis of studies looking at this issue found that there was no good evidence to say that fertility is increased by treatment. If you are infertile, your specialist will be able to advise on current research.

number of follicles (egg sacs) as this increases your chances even more.
If you have IVF, the risk of a multiple pregnancy is limited by replacing one or two embryos.

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The HFEA guide to Infertility | 2007/08

IUI: Intrauterine Insemination
THIS IS A RELATIVELY SIMPLE FERTILITY TREATMENT
WITH A PROVEN TRACK RECORD OF SUCCESS
Intrauterine insemination (IUI) involves inserting sperm into the womb to coincide with ovulation (when an ovary releases an egg) to increase the chances of conception.
This treatment can be used where there is unexplained infertility, or if ovulation problems are identified. So what actually happens?

Is it for you?
The clinic may recommend
IUI if: your sperm count is low or your sperm are poor movers (often referred to as having poor motility) your sperm are not surviving the journey through the cervical mucus (sometimes it can be too thick for the sperm to pass through) or because there are antibodies present that attack your sperm

What to expect

you are experiencing impotence or premature ejaculation.

FOR WOMEN

YOU ASK…
Does IUI hurt?
This treatment is usually fairly painless although you may experience mild cramps similar to period pains.
Very occasionally it may be difficult to get the catheter through your cervix, which can be uncomfortable, but your doctor should offer you painkillers to ease any pain.

How are sperm prepared?
Sperm are washed to remove the fluid in which they swim (seminal fluid) and prepared to select the healthiest specimens that are likely to be the most fertile. The sperm are then placed in the small tube or catheter to be inserted into the womb.

20 | For further information visit www.hfea.gov.uk

If you are not using fertility drugs
(known as an unstimulated cycle), IUI is done between day 12 and day 15 of your monthly cycle - with day one being the first day of your period. You are given blood or urine tests to identify when you are ovulating, or you can use an ovulation predictor kit.
You may, however, need fertility drugs to stimulate ovulation (a stimulated cycle), which, if prescribed by your doctor, usually come as an injection and nasal spray (see page 18). Your eggs are tracked by vaginal ultrasound scans as they develop. As

soon as an egg is mature, you are given a hormone injection to stimulate the egg’s release.
The sperm is inserted 36 to 40 hours later. The doctor inserts a speculum
(a special instrument that keeps your vaginal walls apart) into your vagina through which they then thread a small catheter (a soft, flexible tube) into your womb via your cervix.
Sperm, which have been previously prepared to select the healthiest ones, are then inserted through the catheter. The whole process takes just a few minutes. You may wish to rest for a short time before going home - ask your clinic what they recommend. FOR MEN
You will be asked to produce a sperm sample on the day the treatment takes place.

2007/08 | The HFEA guide to Infertility

Donor insemination

Success rating

Donor insemination is where sperm is placed into a woman’s reproductive tract at the time of ovulation to achieve a pregnancy. This can be carried out in a clinic using IUI.

The success rates for IUI using fertility drugs are around 15 per cent per cycle of treatment, provided that the man’s sperm and the woman’s tubes are both healthy. As with other treatments, IUI tends to be more successful if the woman is younger and, therefore, more fertile.

Prior to treatment, all donor sperm will have been properly screened for infections such as hepatitis and HIV.
This means freezing the sperm with a quarantine period of six months. From 5
July 2007, fresh sperm, other than your partners would need to go through the same screening process. This is due to a change in the law to improve patient safety and standards.

See the section on ‘Using donated sperm, eggs and embryos’ for more information. The expert says...
‘IUI is one of the simple methods of helping couples with fertility problems.
For unexplained infertility, IUI is usually the first line of treatment. This can be followed by IVF if unsuccessful.’

After the treatment you will be booked in by the clinic for a pregnancy test to see if the treatment has been successful. If it fails after several attempts, it suggests that there may be some underlying reason for your infertility and, depending on your age, your doctor may suggest you go on to try another treatment such as IVF. All things being equal, it would be reasonable to try three to six IUI treatments.

Our story: Learn what you can about treatment

Seeta, 33, and her husband Tahir, 40, had been trying for a baby for a year without success. Initial tests suggested PCOS, which later proved not to be the case. After treatment the couple, who live in Kilbarchan,
Scotland, had their daughter, Hema.
Seeta tells their story:
Treatment time
‘I was initially diagnosed with polycystic ovary syndrome (PCOS) and then with unexplained infertility. We tried Clomid, which didn’t work, and then were referred for IUI. After three failed cycles on the NHS, I conceived our daughter,
Hema. The nurses were really good, friendly and kind and responsive to our needs. But there were a lot of frustrating silly little things which would wind me up, such as long waiting times at the clinic, meaning I got back to work late.’

Feelings
‘We felt out of control because we were being told what to do and had no say in what we were offered. At first I thought that the drugs would work and then I hoped that IUI would work first time.
When it didn’t I got upset and found it difficult. Even though I had a fantastic pregnancy and sailed through it and the birth, I never let myself think any further ahead than I was at the time. As a result when Hema was born at 37 weeks we had bought very few clothes and equipment.’ ‘Coming from an Asian background, infertility is something that is not discussed openly although we ourselves didn’t feel that there was a stigma. We told a few people outside our immediate family and friends and I distanced myself from some people who I felt were not supportive for a while.’
‘We felt it was quite personal and didn’t want everyone knowing. We didn’t want to keep telling everyone if cycles failed at a time when we were still trying to get our own heads around it.’
‘People think that because they got pregnant easily it’s easy for everyone and they can come out with hurtful

comments. Although unintentional, you are very vulnerable when you are going through treatment.’
Our relationship
‘It was hard at times because both of us were in different places at different times. Talking through things brought us together and I would say it has made us stronger as a couple.’
Our tips
Remember you are not alone.
Once you tell people they often say,
“I know someone who has been through that”.
Learn what you can about treatment.
We knew very little when we first embarked upon it but as time went on we learnt a lot more. There’s plenty of information about the technicalities, but nothing about how you are going to feel during or after treatment, or about complementary treatments. After the third attempt at
IUI, I went to see a Chinese medical practitioner and had acupuncture and Chinese herbs. I also did yoga and we joined the west of Scotland support group, Cradle. This gave me some control back, which was great.

For further information visit www.hfea.gov.uk | 21

The HFEA guide to Infertility | 2007/08

IVF: In Vitro Fertilisation
IN THE UK ALONE, APPROXIMATELY ONE BABY IN EVERY 80 IS BORN AS A
RESULT OF IVF TREATMENT. IT HAS BECOME ONE OF THE MOST POPULAR
TREATMENTS, BRINGING HOPE TO THOUSANDS OF COUPLES
IVF literally means ‘fertilisation in glass’, hence the familiar name of ‘test tube baby’.
Eggs are removed from the ovaries and fertilised with sperm in a laboratory dish before being placed in the woman’s womb.

Is it for you?
The clinic may recommend IVF if: you are an older woman you have been diagnosed with unexplained infertility your tubes are blocked you have been unsuccessful with other techniques such as ovulation induction or IUI.

What to expect
FOR WOMEN

3 Collecting eggs
Eggs are collected by ultrasound guidance or, occasionally, by laparoscopy.

IVF involves several complex steps.
Techniques differ from clinic to clinic but a typical pattern of treatment might go like this:

Ultrasound guidance takes around
30 minutes and you are either given a drug to make you drowsy or a general anaesthetic. Using vaginal ultrasound to produce pictures on a screen, your doctor inserts a thin needle through your vagina into each ovary. They then guide the needle into each egg sac in turn, sucking the egg into it.

1 Boosting egg supply
At the start of your treatment your doctor gives you drugs to block the hormones your pituitary gland usually produces during your monthly cycle.
This allows them better control over when your eggs are produced. You then take different drugs to make your ovaries produce more than one egg
(see page 18).

Laparoscopy is done under a general anaesthetic. Your doctor inserts a laparoscope (small telescope with a light attached) through a small cut in your stomach followed by a fine needle to remove the eggs as before. Nowadays, it is rare for laparoscopy to be used.

2 Checking on development
Vaginal ultrasound scans are carried out to monitor your developing eggs. The clinic will also do blood tests to chart the rising levels of oestrogen produced by the eggs.

4 Collecting sperm

As soon as the tests show that the time is right, you will have another injection of a different hormone to help your eggs mature. Timing is crucial, as you must have this injection 34-38 hours before your eggs are collected - this may mean you having it last thing at night.

Around the time your partner’s eggs are collected, you produce a fresh sample of sperm. This will be stored for a short time before the sperm are washed and spun at a high speed, so that the healthiest and most active can be selected. If you are using donated sperm, the sample is taken

22 | For further information visit www.hfea.gov.uk

from the freezer and prepared in the same way.
5 Fertilising the eggs
Your eggs are mixed with your partner’s sperm and left in a laboratory dish for
16-20 hours before they are checked to see if any have fertilised. Any that haven’t, or any that have fertilised abnormally, are discarded. The remaining embryos are then left for another 24-48 hours before being checked again.
6 Preparing for pregnancy
Two days after your eggs have been collected, you are given progesterone via pessaries, injection or gel to help prepare the lining of your womb.
7 Transferring the embryos
Two to five days after fertilisation, one or two healthy embryos are usually chosen and put back into your womb through your cervix via a catheter (a fine, thin tube). The decision about how many embryos are transferred is important because it affects not just your chance of conceiving but also your chance of having a multiple birth (see page 24).
Remaining embryos may be frozen for future IVF attempts, if they are suitable
(see page 36).

2007/08 | The HFEA guide to Infertility

Success rating
It is often thought that IVF has a high failure rate, but the overall success rate for conception is about the same as in nature and sometimes better. The chances of you having a baby, though, are slightly lower as women may miscarry early on, just as in natural conception.
Female fertility diminishes with age, so if you are using your own eggs, the younger you are, the higher your chances of success. One in four women under
30 have babies after IVF, but only one in ten by the age of 40.

The expert says...
Although hugely popular, IVF is not the answer to all fertility problems and is only recommended where there is a genuine reason and/or because simpler methods have failed. For women over 40, IVF cannot overcome the decline in the number and quality of eggs that is part of the natural ageing process.

Further options
Blastocyst transfer
IIf you have good quality embryos but they fail to implant in the womb, your doctor may suggest you try blastocyst transfer. This allows your embryos to develop to what is known as the blastocyst stage before they are put back in the womb. A blastocyst is an embryo that has developed for five to six days after fertilisation by which time it has two different cell types and a central cavity.
Allowing your embryo to develop for longer can increase your chances of a successful pregnancy.

Assisted hatching
Before an embryo can attach to the wall of the womb (known as implanting), it has to break out or ‘hatch’ from a gel-like shell called the zona pellucida. Some embryos have a tougher shell than others, which makes it more difficult for them to do this.
Making a hole in or thinning this shell (using acid, laser or mechanical methods) may help embryos to ‘hatch’. Some clinicians believe that the use of assisted hatching results in better pregnancy rates, while others feel there is still too little information to support its use. If your clinic suggests this treatment, do talk it through with them, asking why they are recommending it and what the perceived benefits will be in your case.

Our story: We felt left out, not having a baby private clinic where we had two more attempts.This time we were offered both
ICSI and assisted hatching to help things along and I conceived Louis on the second attempt.’

Feelings

Kate, 37, a self-employed advisory teacher and her husband Rupert, 40, programme manager at a college of further education, live in
Twickenham. They had their son,
Louis, aged 18 months, after three attempts at IVF. Kate tells their story:
Treatment time
‘After an initial diagnosis of unexplained infertility, we discovered that my problem might be PCOS-related. When our first attempt at IVF using ICSI, funded by the
NHS, failed we decided to go to a

‘Initially I experienced a deep sense of emotional disappointment as if I had been let down by my own body. Over the next nine years my emotions veered between defeat to determination, anger and resignation. Although we didn’t feel there was any stigma attached to being childless we felt left out because we didn’t have a baby.’
‘We did not want to add to the taboo of infertility by not telling anybody. On the whole people were overwhelmingly supportive although there were a few who said foolish or hurtful things. We lost a few friends but collected a lot of godchildren! Although we love them, what we really wanted was our own children. My mum found it hard to know how to support me, but she found a helpline for relatives of people with infertility that was great.’

Our relationship
‘Although it brought us closer together it put a strain on our daily lives. When it was clear that we would need IVF, we agreed I’d become a part time advisory teacher. Rupert didn’t have such an option. If there is a plus point, it’s the fact that we had learnt how to live with each other before we had children.’
Our tips
Find emotional support. Fertility clinics are places of science and medicine rather than emotions. Find someone outside your relationship to offer you TLC.
Make time to talk through all the stages of your treatment with your partner. Attend appointments together and go for coffee afterwards to talk. Listen to each other without judgement and be loving.
You may not instantly bond with your baby. I was anxious during my pregnancy and didn’t enjoy it. It took a couple of weeks to recover and fall in love with Louis.

For further information visit www.hfea.gov.uk | 23

The HFEA guide to Infertility | 2007/08

IVF: In Vitro Fertilisation
YOU ASK…
I’m 35. Can I have IVF on the NHS?
As long as you are between the ages of
23 and 39, you should be able to have at least one cycle of treatment funded by the NHS. There are various criteria to qualify for funding, including if you or your partner have been diagnosed with a fertility problem or if you have been trying to conceive for at least three years, and do not already have children
(see pages 10-11).

Our doctor is sending us to an IVF clinic that’s miles away from where we live. Can I have treatment closer to home?
You may be able to have ‘satellite’ IVF which means that most of the early stages of treatment can take place at your local clinic or hospital. Only the actual placing of the embryos in your body is done at the IVF clinic.
The big advantage of satellite IVF is that it’s less disruptive so you might not need to take time off work. You will also save the time, cost and energy of travelling backwards and forwards to the IVF clinic. Sometimes eggs can also be retrieved at the local unit and then taken to the IVF clinic in a portable incubator.
This is known as ‘transport IVF’.
You can find HFEA-licensed clinics with satellite or transport centres on the ‘Find a clinic’ search at www.hfea.gov.uk.

What is natural cycle IVF?
Natural cycle IVF involves collecting and fertilising the one egg that you release during your normal monthly cycle. This avoids the side effects of fertility drugs
(see opposite) and you are also less likely to have twins or triplets. And because your ovaries aren’t being artificially stimulated, they don’t need to rest after IVF. So should your treatment be unsuccessful, you can try again sooner if you wish.

Treatment reactions
Pregnancy rates are more or less the same as with conventional IVF over three to four attempts. It may be worth trying if your periods are fairly regular and you are ovulating normally, but you have blocked tubes or unexplained infertility.
Not all clinics offer this treatment.

How many embryos should I have transferred during IVF?
Research shows that, for many women, limiting the number of embryos transferred during treatment to two reduces the number of multiple pregnancies, without causing a significant decrease in the pregnancy rate. This is why the HFEA guidelines say that clinics should transfer a maximum of two embryos to women under 40, while women who are 40 or over can have a maximum of three transferred.
Where donor eggs are used, the maximum number of embryos that can be transferred is two, regardless of the age of the woman having IVF. This is because the egg donors are fertile women who have to be under the age of 36.
Some clinics now offer the transfer of one embryo to certain women, normally those under 35 with a good chance of success, particularly if they are having blastocyst transfer (see page 23)

Why would I want to avoid a multiple pregnancy?
Although having twins may have some appeal because two children are an instant family, you need to bear in mind the increased risks and pressures associated with multiple births. If you are carrying more than one baby, the pregnancy and birth are more likely to have complications, both for you and for your babies. For more information, visit www.hfea.gov.uk/ForPatients. Did you know?
Scientists and doctors took over ten years to develop IVF treatment.
Louise Brown, who was born in July 1978 to a blaze of publicity, was the first ever ‘test tube’ baby.

24 | For further information visit www.hfea.gov.uk

Like all medical treatments, IVF has risks as well as benefits. These can include reactions to drugs and certain pregnancy problems.
Drug reaction
What it is: A mild reaction to fertility drugs. Symptoms: Hot flushes, feeling down or irritable, headaches and restlessness.
What to do: Nothing. If symptoms don’t get worse they usually disappear.
Ovarian hyper-stimulation syndrome (OHSS).
What it is: A potentially dangerous over-reaction to fertility drugs used to stimulate egg production. Cysts develop on your ovaries and fluid collects in your stomach. In severe cases (about 1-2 per cent) your ovaries become very swollen and fluid may fill the stomach and chest cavities. A fall in the concentration of red blood cells can lead to blood clots and blood flow to the kidneys may also be reduced. Symptoms: Swollen stomach and stomach pains. In severe cases nausea and vomiting, severe stomach pains and swelling, shortness of breath, faintness and reduced urine.
What to do: OHSS is potentially very serious, so if you start to experience any of the above symptoms you must contact your clinic immediately. They may decide to stop treatment. If you are badly affected you may have to go to hospital as an emergency. For more information, visit www.hfea.gov.uk/ForPatients Ectopic pregnancy
What it is: When an embryo develops in your fallopian tube rather than your womb. The chances of an ectopic pregnancy seem to be higher in women having IVF especially if they already have problems affecting their tubes.
Symptoms: Vaginal bleeding, low pregnancy hormone levels and, if pregnancy continues, miscarriage and a risk of the tube bursting.
What to do: You should have a pregnancy blood test to check for the pregnancy hormone, hCG. If you are pregnant you should also have a scan at six weeks to check for the baby’s heartbeat and to make sure it is growing properly in the womb. Report any vaginal bleeding or stomach pain to the doctor.

2007/08 | The HFEA guide to Infertility

Genetic testing
Several centres in the UK are currently licensed to carry out tests on embryos to detect certain inherited diseases and problems to ensure that only unaffected embryos are selected before being placed back in the womb.
Conventional tests for genetic diseases cannot be carried out until the 12th week of pregnancy so testing embryos before they are implanted could help you and your partner to avoid having to make the difficult decision of whether to have a termination (abortion) if either of you is the carrier of a genetic disease and the embryo is affected.
The tests are high-tech and therefore expensive. Pre-implantation genetic diagnosis (PGD)
If you have had several terminations because your baby had a genetic disease or you already have a child with a genetic disease and are at high risk of having another, you might want to consider PGD.
It involves checking the genes of threeday-old embryos conceived by IVF for genetic diseases such as haemophilia and cystic fibrosis. There are currently ten UK clinics who offer this treatment.
How is it done?
In the laboratory, one or two cells are extracted from the embryo and are examined to see if they are carrying the culprit genes. Some genetic diseases, such as Duchenne muscular dystrophy, only affect males. In this case the cell is examined to find out the embryo’s sex and only female embryos are replaced.
This procedure is not allowed simply to ensure you have a baby boy or girl to balance your family.
Some serious or life-threatening genetic diseases may be treated using stem cells from a family member whose tissue is a genetic match for the affected person. Not all family members have the same tissue type.
In extremely rare cases, where no suitable donor can be found, parents of a child affected by a serious genetic disease may try to have a new baby in the hope that the blood from its umbilical

cord, which is rich in stem cells, may be used to treat the existing, affected child.
Their chances of having a baby whose cord blood may be used in this way can be increased by using PGD to identify embryos with a tissue type which matches that of the affected child.
This is a very complex and demanding procedure and may be used only where the condition of the affected child is serious or life threatening. The procedure must be authorised by the HFEA on a case-by-case basis.
Find a list of conditions which PGD has been licensed for under ‘treatments explained’ on www.hfea.gov.uk

Pre-implantation genetic screening (PGS)
If you are over 35, with a high risk of having a baby with a chromosome problem such as Down’s syndrome, or have a family history of chromosome problems, you may want to consider
PGS. It may also be offered if you have a history of recurrent miscarriage or have had several unsuccessful
IVF treatments.
PGS involves testing embryos produced by IVF to make sure they have the right number of chromosomes. It is also called aneuploidy screening. Aneuploidy

is where the embryo has the wrong number of chromosomes - for example,
Down’s syndrome, where there are three number 21 chromosomes instead of the usual two.
How is it done?
As for PGD, except that chromosomes are examined to see how many there are and if they are normal. There are currently eight UK clinics who offer this treatment (visit ‘Find a clinic’ on the
HFEA website for details).

Chromosome counts
Chromosomes are tiny structures found in the centre of each cell in the body. Each chromosome carries thousands of genes, which instruct your body how to work.
Chromosomes are made up of two chains of genetic material called
DNA. There are 23 pairs of chromosomes (46 altogether) in each of our cells, except for eggs and sperm, which each have 23 chromosomes. When these fuse together they create a single human being with the usual 46 chromosomes. FURTHER INFORMATION
Visit www.hfea.gov.uk/ForPatients

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The HFEA guide to Infertility | 2007/08

ICSI: Intra-Cytoplasmic Sperm Injection
INJECTING AN EGG WITH SPERM CAN BE A SUCCESSFUL ANSWER
TO MALE INFERTILITY ISSUES
Intra-cytoplasmic sperm injection (ICSI), which involves injecting a single sperm into the cytoplasm or centre of an egg, is the biggest advance in infertility treatment since
IVF. It was introduced in 1992 and the next

Is it for you? The embryologist will examine your sperm under a microscope and decide whether ICSI could increase your and your partner’s chances of having a baby.
It may be performed if:

year the first UK baby from ICSI treatment was born. Over 4,500 babies were born in the UK during 2003/04 as a result of this revolutionary treatment for male infertility.
So what actually happens?

FOR MEN your sperm count is very low your sperm cannot move properly or are abnormally shaped there are high levels of anti-sperm antibodies in your semen you and your partner have tried previous IVF treatment but few or no eggs have fertilised

your partner has responded poorly to ovarian stimulation, producing few eggs of which few have been able to be fertilised
Sperm has been retrieved directly from the epididymis (PESA or
MESA) or the testicles (TESE) or, rarely, by electroejaculation.

What to expect
FOR WOMEN
You take fertility drugs to stimulate your ovaries to produce more eggs, which are collected on a certain day as for IVF (see page 22). These are then fertilised with your partner’s sperm (see below) and replaced in your womb in exactly the same way as for conventional IVF. Any suitable embryos not used at this stage can be frozen for future use. After the treatment, your clinic will arrange a future date with you for your pregnancy test.

26 | For further information visit www.hfea.gov.uk

FOR MEN
You produce a fresh sperm sample on the same day as your partner’s eggs are collected. Your sperm are then used to fertilise her eggs by injection before they are returned to the womb.

2007/08 | The HFEA guide to Infertility

YOU ASK…

Success rating

I’ve heard that ICSI can cause birth defects. Is this true?

ICSI can hugely boost your chances of conception as the sperm don’t have to travel to the egg or penetrate it. Success depends a lot on the skill and experience of the clinic, but as the technique becomes more widespread,

As ICSI is still relatively new, there have been some concerns that injecting the sperm into an egg could damage it and lead to birth defects.
However, the first results from an ongoing study led by London paediatrician Dr Alistair Sutcliffe, published in July 2003, were encouraging. success rates continue to improve.
As with IVF, the younger the woman, the higher the success rate.
Age is less important for men as sperm are freshly made and only healthy sperm will be used for ICSI. The quality of sperm, however, does decrease as men age.

Our story: Give yourself time

The study compares 541 children conceived by ICSI and 440 by IVF with 542 who were conceived naturally. It showed that at the age of five, the ICSI and IVF children were doing just as well as the ones who were conceived naturally. Another concern is that infertile men could pass on their infertility to their sons born through ICSI through their genes. There is no definitive answer to this yet.
As with all risks, it is worth discussing this with your clinic. You might also like to consider talking through your concerns and options with a counsellor or with other couples who have used ICSI.
For more information, see www.hfea.gov.uk/ForPatients. The expert says... ‘ICSI has helped many thousands of couples to have a baby, especially in instances of a man having a low sperm count or poor quality sperm.
But as the reasons for a low sperm count can lie in the genes, which may be passed through the male line, a man should always have a checkup blood test before going ahead with ICSI.’

Annette, 35, a civil servant and
Alan, 39, a chartered surveyor from
Rhondda in South Wales, had been trying for a baby without success for two years. Tests revealed that poor sperm motility could be the reason. Annette tells their story:
Treatment time
‘We didn’t really have any treatment choices because of Alan’s problems with his sperm, so IVF with ICSI was our only chance of having a baby. After two unsuccessful treatment cycles we changed clinics and after a third cycle our twins Ffion and Lowri, who are now 14 months old, were conceived.’
Feelings
‘The whole experience is emotionally and physically battering. I remember sitting at my desk feeling utterly drained and thinking
“will I ever get over this?”. I didn’t realise it was going to be as difficult as it was. But it was all worth it in the end. We have two lovely little girls and despite all the ups and downs I’m now over the moon.’
‘At first we didn’t tell anyone except my mother and work colleagues who knew because I had to have time off work for the first couple of rounds of treatment.
But when we were asked at a family party yet again, “when are you going to start a family?”, we decided to be honest.
Most of our family and friends were

supportive. But there were some who said irritating things like “all you need is a weekend and a bottle of wine and you’ll be fine.”
Our relationship
‘Going through treatment brought us closer together. When things were bleak we would think at least we’ve got each other. That’s the main thing.’
Our tips
Give yourself time to recover between treatments. I had the second treatment straight after the first and in retrospect, I wish I had given myself more time to recover.
Stay positive. Our worst fear was that it was going to fail.
Be aware how difficult you may find pregnancy. When I did conceive it was almost: “Okay it worked. Now what?”
I didn’t enjoy pregnancy and because the twins were born early I found it hard to get close to them. I suppose it was self-preservation - I didn’t want to get too attached in case it all went wrong.
Get some support. I wish I’d had more support when we first started out. We did get support from family and friends but unless you have been through it yourself you have no real idea how it affects people.

For further information visit www.hfea.gov.uk | 27

The HFEA guide to Infertility | 2007/08

GIFT: Gamete Intra-Fallopian Transfer
GIFT IS ONE OF THE EARLIEST FERTILITY TREATMENTS AND
IS STILL GOING STRONG TODAY
Gamete intra-fallopian transfer (GIFT) starts off with gametes (your eggs and sperm) being collected in exactly the same way as for IVF. The healthiest are chosen, mixed together and placed in one of the fallopian tubes (the tubes down which eggs pass from the ovaries to the womb). Fertilisation takes place inside the body, just as it could have done had you not had medical intervention.
So what actually happens?

Is it for you?
FOR WOMEN
GIFT can help in many cases of unexplained infertility, for example, when your fallopian tubes aren’t blocked or damaged.

Success rating
This varies across clinics, but around 25-30 per cent of women usually get pregnant in any one treatment cycle. Like most fertility treatments, GIFT is most successful in younger women.

FOR MEN
GIFT can help if you have a low sperm count or sperm with poor movement (low motility).
Your doctor may suggest you try IVF to make sure your sperm can fertilise your partner’s eggs.
If successful, GIFT may be used in the next treatment cycle or cycles instead of repeating IVF.

YOU ASK…
Is GIFT licensed by the HFEA?
Yes, from 5 July 2007, this treatment requires a licence when using partner/donor sperm or eggs in treatment.

What to expect
FOR WOMEN
Before proceeding with GIFT, you may be given a hysterosalpingogram (uterine dye test) and a laparoscopy to check your fallopian tubes are healthy and clear. Up to the point of egg collection,
GIFT is exactly the same as for IVF
(see page 22).
Your doctor will make a small 5mm cut in your tummy (under anaesthetic) so that they can insert a laparoscope

(small telescope with a light attached) to view your womb and fallopian tubes.
The healthiest one or two eggs are then mixed with the prepared sperm in a catheter (a fine, flexible tube). The doctor inserts the catheter to deposit the eggs at the end of one or both fallopian tubes, nearest the womb.
You need a short rest before going home and will be given some progesterone, via injections, pessaries or gel, to build up the lining of your womb to provide a good environment for any fertilised eggs.

28 | For further information visit www.hfea.gov.uk

FOR MEN
You are asked to provide a sperm sample on the same day that the eggs are collected. If donor sperm are being used, they are carefully thawed before being mixed with the collected eggs.

2007/08 | The HFEA guide to Infertility

Using Donated Sperm, Eggs or Embryos
NEARLY 2,000 CHILDREN ARE BORN EVERY YEAR IN THE UK USING DONATED
SPERM, EGGS OR EMBRYOS. THERE ARE A NUMBER OF SITUATIONS WHERE
THIS CAN BE APPROPRIATE AND CREATING A FAMILY IN THIS WAY CAN BE
VERY FULFILLING
The decision to go down this route, however, is not a straightforward one. It is strongly recommended that you and your partner, if you have one, talk to an experienced

Before you begin
It is tough going through fertility treatment, but the decision to use donated sperm, eggs or embryos will have a far-reaching impact on you, your partner and your relationship with your respective families.
You will need to be sensitive to your own and your partner’s feelings and to give yourselves time to think everything through. Don’t rush into treatment - only go ahead when you feel ready.
Don’t go it alone. Most clinics run local patient support groups. The Donor
Conception Network is a national support network for people considering treatment using donor eggs, sperm or embryos, and for those who already have children conceived in this way (see page 44).

Pause for thought
You may be considering using donated sperm, eggs or embryos because other fertility treatment has been, or is likely to be, unsuccessful.
Coming to terms with this can be like coping with a bereavement. Give yourself time to adjust.
If you have a partner, you probably wanted to have their baby, not that of another man and/or woman, so it’s not surprising if you feel a sense of loss at losing that genetic connection.
If you are single, you may be letting go of the hope of being a two-parent family, and having a partner with whom to share the parenting.
You may feel guilty that your sperm and/or eggs cannot be used and feel that the fact you are now considering donation is somehow your ‘fault’. You may also worry that your partner blames you for the situation.
You may feel disappointed, sad, angry and/or afraid - and so may your

counsellor and to other people who have chosen this treatment option before making any decisions to go ahead.

partner. It can be difficult to see them struggling to come to terms with their feelings at the same time as dealing with your own. However, it can often help if you are able to talk things through as you each work through your feelings.
Sometimes discussing things with each other only gets you so far. You will cope in different ways. Can you get support from friends or family? Or an experienced counsellor can often help.
Remember: genetic connection isn’t what makes for a loving family as many men and women who have had a child or children using donated eggs, sperm or embryos have proved. Many say that the joy of becoming parents is even greater because of everything they have been through together.

Using donated sperm Using donated sperm in your treatment is an option in some circumstances when using your partner’s sperm would be unlikely to be successful, or if you do not have a male partner.

Is it for you?
This may be an option if:

FOR WOMEN you are single or in a same sex relationship FOR MEN

YOU ASK…
Will my baby look like me and/ or my partner?
Your clinic can provide details about the physical characteristics of donors available. They will attempt to match donor and patient characteristics. But just as with naturally conceived children, there is no guarantee that your baby will closely resemble the donor. Some ethnic groups are under-represented in the available donated gametes or embryos. If you are from such a group, you may wish to consider finding your own donor.

Can the donor change their mind?
Both you as the person being treated and the donor must give written, ‘effective’ consent. Donors have the right to change their mind at any time in the process until their sperm, eggs or embryos are actually used in treatment.

you are producing little or no sperm your sperm is unlikely to be able to fertilise an egg you have a high risk of passing on an inherited disease you have had a vasectomy

What to expect
The clinic may do a pre-pregnancy check, including: details of your and your family medical history; a physical examination; ultrasound scan and blood tests; blood sugar and blood pressure check. They may also run some tests to make sure that you are producing eggs and that your fallopian tubes are healthy.
Treatment takes place at the time you ovulate (when an egg is released from an ovary). Some clinics recommend fertility drugs to help maximise your chances.

For further information visit www.hfea.gov.uk | 29

The HFEA guide to Infertility | 2007/08

Using Donated Sperm, Eggs or Embryos
An end to donor anonymity
Until April 2005, if you conceived using donated sperm, eggs or embryos, the donor could remain anonymous. However, the overwhelming view of donor-conceived adults these days is that children born as a result of donation should be able to find out about their genetic origins.
As a result, the law was changed and children born from sperm, eggs and embryos donated after April 2005 will be entitled to information about the identity of their donor once they are 18 years old.
Except in certain limited circumstances, sperm, eggs and embryos from anonymous donors can no longer be used.

(If a donor-conceived person is planning to marry or start a family, they can contact the HFEA to find out if they are related to their potential partner.)
If the donor registered (or re-registered) after 1 April 2005, the donor-conceived person can apply for the following identifying information about the donor:

year and country of birth ethnic group, and their parents’ ethnic group(s)

One of the key issues to think about is what and how you will tell your child about the way they were conceived.
Ideally, you will be able to talk openly about it from birth onwards. It is crucial that your child learns about their origins from you, and not from other people, so it is worth thinking about when it would be most helpful to introduce them to the idea
- perhaps when they are asking questions about where babies come from, for example. Later, as they become more aware of the facts of life, you may want to give them a more detailed explanation.

name, and name at birth if different

Once donor-conceived people reach the age of 18, they are entitled to apply to the
HFEA to find out the following nonidentifying information about their donor from the HFEA’s register: physical description (height, weight, eye and hair colour, skin colour)

Looking to the future date and place of birth latest known address physical appearance the donor’s ID number at the centre
For more information about the HFEA
Register, and what information can be given to a donor-conceived person, their parents, and to the donor, visit For
Donors on www.hfea.gov.uk

If you, as the parent, are open about how your child was conceived, and treat it as normal, there is no reason they should feel any different to any other child. As they grow older, they will start to understand the implications, but if donation has been part of the family story for as long as they can remember this shouldn’t be a problem. Some are likely to want to know more about their donor while others won’t be particularly interested.

whether they were adopted marital status how many children they already have (if applicable) and the gender of those children

Pause for thought

details of donor screening tests and medical history any other details the donor may have provided, such as information about their occupation, religion, interests and skills, reasons for donating, and a goodwill message.

30 | For further information visit www.hfea.gov.uk

How do you feel about using eggs, sperm or embryos from someone you don’t know? It can help to find out as much as you can about the donor.
How will you feel if your child decides to contact the donor when they are 18?

The Donor Conception Network publishes books and other materials to help you tell children about donor conception and it can be helpful to talk to and potentially meet other parents who have experience of sharing this information. Once a donorconceived person reaches the age of 18, or earlier if they plan to marry, they can ask for information about their donor from the HFEA Register.

2007/08 | The HFEA guide to Infertility

Using Donated Sperm, Eggs or Embryos
In donor insemination (DI), the sperm are put into a thin tube which is then used to place the sperm at the entrance to your cervix (the neck of your womb) or into the womb itself, using IUI (see page 20).
After this you will be advised to rest for a while before going home. It is often possible for your partner to be with you ask your clinic.

Success rating
As with all treatments using your own eggs, the younger you are, the greater your chances of success are likely to be.
For women under 35, the success rate is around 14 per cent for each attempt. This falls to 8-9 per cent for the 35-39 age group and 4-5 per cent for those between 40 and 42.

The expert says...
‘If the male partner has no sperm, or a very poor sperm count, and other treatments have failed, or when he risks passing on an inherited disease, we recommend DI. Where the woman has no fertility problems of her own, some couples prefer DI to ICSI as it avoids them having to go through IVF.’

YOU ASK…

Will I be considered for treatment if I don’t have a partner?

We would like to have more than one child. Will we be able to use the same sperm donor in the future?
Yes, provided the sperm is available
(this may not always be possible) and the donor’s consent permits this. It is worth letting your clinic know that you may wish to use the same donor in the future.

We have a child conceived using an anonymous donor. If we have another child using sperm from the same donor, can he still be anonymous? Yes. However, the donor can re-register to be identifiable any time now and in the future. If he does, then your existing child and any other children born from his donation will be able to obtain identifying information about him from the HFEA
Register (see left).

How many other women can use the same donor as me?
A donor’s sperm may be used to create up to ten families excluding their own. So your children may share a partial genetic link with children in up to ten other families.

Clinics have different eligibility criteria.
It is worth checking these with your chosen clinic at the outset. By law, before the clinic treats any patient, they have to consider your potential baby’s welfare
(including “the need for a father” specifically mentioned in the 1990 HFE
Act). If you do not have a partner, it is likely they will ask about your plans for caring for the child on your own.

Can I obtain donor sperm from other countries? Yes. If you wish to obtain sperm from within the EU, your clinic may be able to organise a transfer from that country provided that quality standards set out in
EU law have been met and that the donor is identifiable, has been screened to UK standards and has not received payment for his donation.
If the donor sperm is from outside the EU, your clinic will need to apply to the HFEA on your behalf to import from that country and must demonstrate that they meet UK standards. If sperm from abroad is used you need to think about what you will tell your child about this.

Our story: A child has a right to know treatments and several donors with no success and were about to give up when I became pregnant with Patrick.’

Judy, 52, and her husband Matthew,
42, have a son, Patrick, 12, who was conceived by donor insemination (DI).
Judy tells their story:
Treatment time
‘After two years of trying for a baby we went to our GPs and learnt that Matthew had no sperm. The GP suggested donor insemination (DI). I was pregnant after four treatments but miscarried at nine weeks. We went through another 20

Feelings
‘We were both upset but Matthew had more to come to terms with knowing that he would never have his own genetic child. Our initial reaction to DI was very negative. The idea of having somebody else's baby was appalling. There was a definite 'yuk' factor too. It took several years for us to realise that ultimately being a parent was more important than the genetic aspect.’
‘We were anxious to keep the whole thing secret. It was only after going to the support group and hearing other people being so open about their experiences and fears that we began to tell family and close friends.’

Our relationship
‘The whole process made us feel closer, although during counselling we were surprised to find that we were thinking rather different things about the effects of not having a child. Matthew's greatest fear was that I would miscarry again, while my worst fear was of a kind of emptiness that would stretch on into the future.’
Our tips
Get support. After my miscarriage the clinic nurse, who was always incredibly supportive, suggested that we try the clinic's support group, which we found very helpful.
Be open. We've always been open with Patrick about his origins and strongly believe that a child has the right to know where they came from.
Be positive, be optimistic and keep communicating with each other.

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The HFEA guide to Infertility | 2007/08

Using Donated Sperm, Eggs or Embryos
Using donated eggs Is it for you?

Success rating

Can I be treated in the UK using donated eggs from abroad?

There is an average 25 to 40 per cent success rate for each treatment using donor eggs. This is slightly higher than the average success rate for conventional IVF across all age groups, as donor eggs must come from someone aged 35 or under.

Yes. If you wish to obtain eggs from within the EU, your clinic may be able to organise a transfer from that country provided that quality standards set out in
EU law have been met and that the donor is identifiable, has been screened to UK standards and has not received payment for his donation.

This may be an option if: you have no ovaries or have had them removed you have had cancer treatment which has damaged your ovaries you are post-menopausal you are producing few or low quality eggs you have tried to conceive unsuccessfully using fertility drugs or IVF you have had several recurrent miscarriages you have irregular periods caused by hormonal imbalance you have a high risk of passing on an serious inherited disorder (see also genetic screening, page 25).

What to expect
FOR WOMEN
You and your donor’s menstrual cycles are synchronised and your womb is prepared to receive the eggs. The eggs are collected from your donor and mixed with your partner’s or with donor’s sperm.
Alternatively, the sperm can be introduced directly into the eggs (ICSI, see page 26) to fertilise them. When the embryos begin to develop, they are transferred to your womb as in standard IVF (see page 22).
Occasionally eggs and sperm are transferred together before fertilisation takes place (GIFT, see page 28).

FOR MEN
Unless you are using donor sperm, you will give a sperm sample to check that your sperm are healthy and active. On the day that the eggs are collected you give another sperm sample which is mixed with the donor eggs or introduced directly into the to fertilise them. Occasionally eggs and sperm are transferred together before fertilisation takes place (GIFT).

YOU ASK…
How do I find donor?
Some clinics may offer to put you on a waiting list for an egg donor - do ask them about how long they would expect you to wait. There are some ways you can speed up this process:
You can advertise for an egg donor.
You can ask suitable friends or relatives.
Some clinics enable you to ‘share’ eggs. This is when another woman receiving treatment donates some of her eggs for you to use (provided enough are collected).

If I’m using donated eggs, who is the legal mother of any children born?
The woman having treatment is considered by law to be the baby’s mother, not the woman who donated the eggs. If the woman who is treated has a husband or male partner who gave his consent to the treatment, he is considered by law to be the baby’s father.

The waiting list for donor eggs in the UK is too long - should I go abroad for treatment?
The HFEA inspects clinics in the UK regularly, and licensed clinics have to abide by the HFEA Code of Practice. We do not regulate clinics in other countries.
These may be subject to local standards and regulations, which vary from country to country. You should find out more about the standards of treatment you can expect from a clinic you are considering.
Egg donation is not without risk for the donor. In the UK, donors are not paid and are required to give informed, written consent. They must also be offered counselling and provide information about themselves. This is not standard practice outside the UK. Ask the clinic about their egg donor recruitment processes, and what information about the donor will be available to you and to any child born from the donation. In the UK, the egg donor has no legal responsibility or rights in respect of children born as a result of their donation - this may not be the case in other countries, so you will need to seek independent legal advice.

32 | For further information visit www.hfea.gov.uk

If the donated eggs are from outside the
EU, your clinic will need to apply to the
HFEA on your behalf to import from that country and must demonstrate that they meet UK standards.

Using donated embryos Is it for you?
This may be an option if: you, your partner, or both of you have the sort of fertility problems that mean you are less likely to be successful using your own sperm and/or eggs you or your partner both have a serious condition that would be inherited by any children you have and you wish to avoid passing it on, such as Huntington’s disease (see page 27) you are single and post-menopausal

What to expect
You have IVF treatment in the same way as if you were using your own frozen embryos (see page 39). The physical characteristics of the donors can be matched as closely as possible with those of yourself and your partner.

YOU ASK…
What happens if I want to use embryos from abroad?
If you want to import embryos back to the
UK for treatment, this must be authorised by the HFEA and will be considered on a case-by-case basis.

Who donates embryos?
Most donated embryos are from people who have completed their treatment. If their treatment has been successful, there will be brothers or sisters to your own child. Some couples donate embryos they cannot to use in their own treatment and which they do not wish to freeze.

2007/08 | The HFEA guide to Infertility

Using Donated Sperm, Eggs or Embryos
Becoming a donor
There are many reasons to become a donor. You might want to help others or, if you have children of your own, you might want others to have the opportunity to be a parent. Your decision will have an important impact on the people who receive your donation, on any children born as a result and on you. It’s important to think carefully about how you feel now and how you may feel in the future.
Donating sperm, eggs or embryos is very different to donating organs or blood. You are potentially creating a new human being. You will have a genetic link with any child created. The clinic will offer you counselling before you go ahead. This gives you a chance to discuss what is involved and consider future implications.
You may also wish to contact the National
Gamete Donation Trust (see page 45).
How do you feel about donating when you don’t necessarily know if a baby will be born as a result?
How do you feel about the child finding out who you are and possibly wanting to meet you?
How do your partner and your family feel about you donating?
How do you think you will feel in the future knowing that children who are genetically related to you are being brought up by other people?
How might a child you already have feel knowing that they have a brother or sister somewhere, conceived as a result of your donation?

Donating sperm
The HFEA has rules for clinics on selecting sperm donors to help to ensure they are healthy. Obviously this cannot be completely guaranteed. Our criteria are:
Donors have to be between the ages of 18 and 45. Over the past ten years, the average age has increased to between 36 and 40 and many donors already have children of their own.
Donors must be offered counselling and are encouraged to think about the implications of donation.
All centres offering sperm donation have to freeze donated sperm samples for six months. This allows time for the donor to be tested for infections such as hepatitis and HIV. Provided the donor doesn’t show any signs of these diseases or of some other, potentially inheritable, conditions, the sperm can then be used.

Donating eggs
You have the right to decide whether you want your eggs to be used for treatment or for research (or both). You also have the right to say your egg can only be used by a particular woman (a friend or relative, for example).
Your egg supply is boosted and eggs collected in the same way as for IVF (see page 22). To avoid becoming pregnant yourself, you are advised to avoid unprotected intercourse during the time you take fertility drugs, and until after your first period following egg collection.
Egg sharing
If you decide to share the eggs collected for your own IVF treatment with another woman, you are also classified as an egg donor. As with other people donating eggs, sperm or embryos, there are many difficult emotional and social issues to consider, which have been covered elsewhere on these pages. In addition, you should consider:
How might you feel if your eggs make a baby for another couple but not for you?
Who are you going to tell about your decision to donate? If you feel that you can’t tell anyone, this could be a sign that donation isn’t for you.
How might you feel if a child born from your donated eggs wished to make contact with you when they are 18?
How might this affect you and your family - including a child born to you and who is also genetically related to the donor-conceived person?

Donating embryos
If you have completed your family or decided to call a halt to IVF, you may wish to donate any remaining embryos to another person or allow them to be used in treatment. Of course this is your decision, and your embryos can only be used in this way if you give your consent to this in writing.
If you donate your embryos to another person or couple to be used in treatment, the same rules on donation apply as to donating sperm or eggs. This means that any child born from your donation will be able to find out identifying information about you when they reach adulthood
(see page 30).
How do you feel about your embryos making a baby for another person or

couple? If your eggs and your partner’s sperm were used to create the embryos, the children born from them will be genetically yours.
Who are you going to tell about your decision to donate? Particularly if you have a child born from the same batch of embryos, what are you going to tell them about possible brothers or sisters they may never meet?
How might you feel if a child born from your donated embryos wishes to make contact with you, and possibly your children, when they are 18?

YOU ASK…
What if I change my mind after donating? Both you and the person being treated will need to give your written, ‘effective’ consent. You have the right to change your mind at any time in the process until your sperm, eggs or embryos are actually used in treatment.

What legal responsibility do I have for a child born from my donation?
Any child born from your donation is the legal child of the woman treated and her husband or male partner, if she has one.
You have no legal rights or responsibility for the child born. However, since the lifting of donor anonymity (see page 30), identifying information about you will be held about you on the HFEA Register and may be given to any people born from your donation once they are 18 years old.
If you are considering donating fresh sperm for use in treatment outside a clinic
(for someone to use for home insemination or to an internet company, for example), you are considered by law to be the father of the child, with the rights and responsibilities this involves.
We strongly recommend only donating sperm through a clinic.

How much will the clinic pay me for my donation?
Donors cannot be paid in the UK.
However, they can be compensated for costs shown to be incurred through donating. This could include travel or childcare expenses where receipts are provided. Also, donors can claim for the loss of earnings to a daily maximum of
£55.19 up to a maximum of £250 per course of donation.

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The HFEA guide to Infertility | 2007/08

Surrogacy
SOMETIMES, ASKING SOMEONE ELSE TO HAVE A BABY FOR YOU MAY BE YOUR
ONLY REAL OPTION, BUT IT’S NOT SOMETHING YOU SHOULD CONSIDER LIGHTLY

A matter of law
Surrogacy is a very complicated legal area, which is why we recommend that you seek advice from a solicitor before making any decisions. The legal mother of the child at birth

Is it for you?
You may want to consider surrogacy if: you have a medical condition which makes it impossible or dangerous for you to get pregnant and give birth you have been unsuccessful with IVF.
Surrogacy is when another woman carries, and gives birth to a baby for you.
You and your partner (if you have one) are known as the ‘commissioning couple’, while the woman who carries and gives birth to your baby is the
‘surrogate’.
It’s vital that both parties are fully committed to the arrangement and that you understand the implications of what is involved now and in future years. This is why it is so essential to talk these through with an experienced counsellor before you start the surrogacy process. You will also need to get legal advice before starting out (see panel opposite).

What to expect
There are two ways of having a baby with a surrogate:
1. You can use sperm from a male partner, if you have one, and the surrogate’s eggs. In this case, fertilisation is usually done by artificial insemination or by IUI (see page 20).
This is called full surrogacy
(sometimes also referred to as traditional or straight surrogacy).
2. You can use your own eggs and your partner’s sperm, or donated eggs inseminated with your partner’s sperm. This involves IVF (see page
22) which must take place in a licensed clinic. This is called partial surrogacy (also referred to as gestational or host IVF surrogacy).

Pause for thought…

If you are going through a fertility clinic, both you and your partner (if you have one) and the surrogate and her partner
(if she has one) will have to undergo the same processes as if you were all starting any fertility treatment. This includes a
‘welfare of the child’ assessment (see page 13) and screening of donor eggs and sperm if applicable.

34 | For further information visit www.hfea.gov.uk

What are you going to tell your family, friends and colleagues?
How are you going to feel about another woman carrying your baby?
How confident and trusting do you feel about the surrogate?
How do you feel about the possibility of the surrogate having a multiple birth?
If you or the surrogate already have children, what are you going to tell them about the pregnancy and new arrival? How will you prepare them, and deal with their questions and possible anxieties or jealousy?
If the surrogate is a friend or family member, how will you feel about them seeing you bringing up the child they have carried?

The surrogate, as the woman giving birth, will be the legal mother of the child and will be put on the birth certificate until you have applied through the courts for a parental order or adoption. Then legal parentage is transferred to you, or to you and your partner as a couple.
The legal father of the child at birth
Usually the surrogate’s partner or husband will be the legal father of the child and will be put on the birth certificate. In Scotland, it is possible for your partner to be named on the birth certificate, giving him legal parentage. Otherwise, you will have to apply through the courts for a parental order or to adopt the child.
Parental order or adoption
You may only apply for a parental order if you and your partner are married, domiciled in the UK and if the child is genetically related to either one or both of you. To apply for a parental order, the surrogate and the father of the child must consent unconditionally to this being made, and the order must be applied for within six months of the birth. You will need legal advice on applying for a parental order.
If you cannot apply for a parental order, your only option is to adopt the child. In such circumstances, the clinic would be breaking the law if they went ahead and provided treatment before being satisfied that a registered adoption agency is involved in the process. This is a requirement under the Adoption and Children Act 2002 which applies to England and Wales
(the requirements are slightly different in Scotland and Northern Ireland). It is important that you get legal advice before beginning the process.

2007/08 | The HFEA guide to Infertility

YOU ASK…
How can we find a surrogate?
It is illegal for a clinic to find a surrogate for you, so you will need to do this yourself. A relative or friend may be willing to help or you may prefer to find a surrogate who is not already known to you. It’s worth talking to other people who have experience of surrogacy to learn how they found their surrogate. By law, you are not allowed to advertise.

What should we look for in a surrogate? Trust is vital, not least because you will need to agree on issues like antenatal testing - for example, for spina bifida or
Down’s syndrome - and decide what you will do if the baby had a congenital problem. Of course, any potential surrogate should be capable of a safe and healthy pregnancy and birth.

Do we have to pay the surrogate?
No. In some parts of the world surrogates are paid but this is not allowed in the UK. You can pay

‘reasonable expenses’ - costs incurred by the surrogate such as clothes, travel expenses and loss of earnings.

What if the surrogate mother changes her mind?
It doesn’t happen often but she does have the legal right to change her mind, even if the baby is not genetically related to her. This is extremely difficult and painful for everyone concerned, which is why it is so essential that you trust each other and are clear and committed to your arrangement from the outset.

Our story: Ginny and I hit it off right away placed in my womb by IVF. I became pregnant on the second cycle. We had planned a home birth but Bruno was ten days overdue so I ended up being induced at a local hospital. Ginny caught him as he was born and they stayed with him while I went to the ward.’

Mel, 38, and her partner Christopher,
45, have five children aged between
11 and 19. She had IVF to become a surrogate mother to Bruno for
Virginia and Ian. Mel tells their story:
Treatment time
‘Ian and Ginny’s sperm and eggs were used to create embryos and they were

Feelings
‘I have always wanted to become a surrogate. I get the most enormous pleasure from my own children and for someone to have the possibility of having children taken away from them seems so unfair. Ginny and I hit if off right away.
Barely a day goes by when she doesn’t text me a photo of Bruno. We talked and talked before deciding to go ahead. From

the outset it was always their baby but of course you do bond with them; there’s no way you can’t especially towards the end of pregnancy and there was a bit of sadness there when I handed him over.
But all in all it has been the most rewarding experience. I feel hugely privileged to have carried their baby and to think that I have changed the future history of their family.’
Our relationship
‘My partner and kids were fully behind me all the way. He looked after me throughout the pregnancy and was there for the birth.
I couldn’t have done it without him.’

Our story: As I held Bruno in my arms, it felt right

Virginia, 39, and her husband, Ian, 38, already had two children but longed for another. However, Virginia has a disease of the womb called
Asherman’s syndrome. After four operations to try and put things right they learnt the only option of having their own baby was host surrogacy.
Treatment time
‘I had two cycles of stimulation and egg collection at a centre which supported surrogacy. We decided we would do three cycles and then decide whether to carry on trying but on the second attempt Mel became pregnant.’

Feelings
‘The pregnancy felt quite surreal. After going through so much I couldn’t let myself believe we were actually going to have a baby. It did feel odd someone else being pregnant with our child. Until I held him in my arms I couldn’t quite believe it but Mel was fantastic, she really made us feel a part of it from the start.
The birth was the most amazing experience. As soon as I held Bruno in my arms it felt right. Mel always made it clear that he was not her baby but we were respectful of the enormous part she had played. We want Bruno to be proud of being a surrogate baby. We will stay in touch with Mel and she will always be in our minds as Bruno grows up. I want her to be proud of us and the way we bring him up. She’s a real inspiration.
Our relationship
‘We were totally committed to surrogacy and our relationship with Mel and her family. IVF and surrogacy are an

emotional rollercoaster. You need a strong relationship at the outset. Coming through this has made us even stronger.’
Our tips
It’s vital that there is absolute trust between you. I never doubted Mel.
Get support. It’s stressful, both emotionally and physically. We could not have survived it without the support of friends and family.
Go to a clinic that supports surrogacy. We took time to choose one. It’s also important that the hospital where the baby will be born is understanding.
Don’t go it alone. Get advice and support. We chose the organisation
Surrogacy UK because we found the message board and regular gettogethers invaluable. We went to a mediation session to go through everything involved.
Never give up on your dream.

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The HFEA guide to Infertility | 2007/08

Freezing and storing embryos
IF SOME OF YOUR EMBRYOS CREATED DURING AN IVF CYCLE ARE NOT USED
YOU CAN HAVE THEM FROZEN AND STORED FOR USE AT A LATER DATE
During IVF treatment, your ovaries may be stimulated to produce more eggs than usual, which means that you may end up with more healthy embryos than you can use. Under
HFEA rules, clinics can only transfer a maximum of two embryos if you’re under 40 and three embryos if you are 40 or over (and using your own eggs). This is designed to reduce the risk of multiple pregnancy (giving birth to twins, triplets or more).

Most clinics will give you the chance to freeze and store suitable ‘spare’ embryos for future use. This can be as part of the IVF or ICSI package, or as an extra service for which you may have to pay. Your embryos may also be able to be stored for future use if your planned treatment needs to be cancelled after egg collection - for example, if you have overresponded to the drugs (see page 24).

Is it for you?
If you store your embryos it means that if you decide to have another go at IVF you don’t have to go through the expensive, and sometimes difficult, process of egg stimulation and collection all over again. It also means you don’t have to take fertility drugs that put you at risk of ovarian hyper-stimulation syndrome or OHSS (see page 24) and you can maximise your chance of conception from one egg collection. Making decisions together Before your embryos can be stored, the clinic asks you and your partner to sign a form agreeing to their freezing and storage. This includes how long you want your embryos stored for, how they may be used and what you want to happen if one of you dies or becomes incapable of withdrawing your consent.

36 | For further information visit www.hfea.gov.uk

Storage times
Embryos can normally be stored for up to five years, though this can be extended under certain circumstances
(see below). You can change your mind at any time, in which case you should let the clinic know about your decision.
While the embryos are in storage, the clinic should contact you regularly to check that you want them to remain in storage. Don’t forget to let the clinic know if you move, or if your circumstances change in other ways,

2007/08 | The HFEA guide to Infertility

for example, if you split up or divorce.
Should you divorce, this does not automatically mean that either person’s consent is withdrawn.
Towards the end of the storage period, the clinic will get in touch and ask you what you wish to do next, such as extend the storage period, allow the embryos to perish or donate them for research or to another patient.
In certain situations you may be allowed to store your frozen embryos for up to ten years. For example, if you or your partner have been diagnosed as infertile and are likely to want to use your embryos for future tries at IVF or if you are at risk of having a child with a genetically inherited condition.
Very occasionally, you may be allowed to store your frozen embryos for even longer than ten years, for example, if you or your partner become infertile as a result of cancer treatment. In this case the embryos cannot be stored once you reach 55 (unless you turn 55 during the first five years of storage).

YOU ASK…
We want to have another go at IVF using our frozen embryos. What are our chances of success?
Your chances of having a baby using a thawed frozen embryo are slightly lower than with a fresh embryo. The good news is that your chances of becoming pregnant with a thawed frozen embryo are not affected by how long the embryos have been stored.

What happens when we want to use some of our frozen embryos?
It all depends on why you need fertility treatment and what your doctor advises.
If your periods are regular and your clinic offers treatment every day, your doctor may suggest using a natural cycle. In this case, ultrasound scans may be used to check your developing eggs and urine or

The freezing process
Only embryos which are developing normally and have not fragmented are suitable for freezing. Before your embryos are stored they are frozen in a vat of liquid nitrogen.
The medical term for this is cryopreservation, from the Greek word cryo meaning cold. A special liquid called a cryoprotectant is added to protect the embryos against freezer damage.

Even when great care is taken, however, some embryos do not survive freezing and thawing. This is why, when it comes to your next treatment cycle, you may be advised to have more embryos thawed than can actually be transferred. Both of you will need to consent again to any future use of your embryos.

Donating your embryos
Alternatively, if you have completed your family or decided to call a halt to IVF, you may wish to donate your embryos to another person or allow them to be used in research. Of course this is your decision, and your embryos can only be used in this way if you give your consent to this in writing.
If you donate your embryos to research, they could be used in studies to help IVF technology, or in stem cell studies.

For more information about research projects licensed by the HFEA, visit How we Regulate on www.hfea.gov.uk.
If you donate your embryos to another person to be used in treatment, the same rules on donation apply as to donating sperm or eggs. This means that any child born from your donation will be able to find out identifying information about you when they reach adulthood (see page 30).

blood tests to check when you are ovulating (releasing an egg). This means your doctor can thaw and replace the embryos when the lining of your womb is at its most receptive.

to happen, either by telephone or in writing. This is why it is so important to let your clinic know if your contact details change.

If your periods aren’t regular, or you don’t have them at all, your doctor may suggest you use drugs to dampen down your natural hormones and trigger a
‘false’ period. You are then given progesterone to help prepare your womb for an embryo. The embryos are then thawed and replaced in the womb
(see page 22).

Wasn’t there a high profile mix-up with some frozen embryos, which led to a couple having another couple’s baby? Could this happen to us?

What happens if my partner or
I withdraw consent?
Who do the embryos belong to?
The law states that if either of you withdraws consent, the clinic has to remove the embryos from storage.
Under HFEA rules, the clinic must inform both parties that this is about

It is very unlikely these days. All clinics have a system for double-checking the couples being treated and the identity of the eggs, sperm and embryos throughout the culture process. Before embryos are transferred, the woman’s identity is also double-checked. The
HFEA’s Incident Alert System, which was introduced after this mix-up occurred, means that licensed clinics can share any lessons they have learnt from actual incidents or near misses to keep reducing the risk of anything like this happening again.

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The HFEA guide to Infertility | 2007/08

If you become pregnant
MAKING THE SWITCH FROM BEING A FERTILITY PATIENT TO A MUM-TO-BE
MAY NOT BE AS EASY AS YOU IMAGINED. BUT THERE ARE WAYS TO MAKE
THE TRANSITION SMOOTHER
Most clinics will offer you a pregnancy test a couple of weeks after your treatment but if you want to do one for yourself, home pregnancy test kits will also give you a pretty accurate reading at a couple of weeks - do bear in mind that there’s a risk of a test showing a false positive result if it is done too early.
If the result is negative, or you get a weak positive, it’s worth doing another test two weeks

later just to double-check. Whatever the result, don’t forget to inform the clinic so they can enter it on the HFEA register.
If you are pregnant, you may start to notice other clues such as missing your period, feeling or being sick, sore breasts, wanting to go to the loo more often, tiredness, sensitivity to strong tastes and smells, as well as mood swings. your feelings whatever they are, and to remember that most mums-to-be go through a mix of emotions on discovering they are pregnant whether they have been through fertility treatment or not.
Antenatal care doesn’t usually start until around the 12th week of pregnancy but you may feel you need some support during these first few weeks. Some clinics will encourage you to stay in touch and you may find it helpful to talk to one of their counsellors. The clinic may be able to put you in touch with other women who have had a baby after fertility treatment and will be able to empathise with how you are feeling. There are also groups you could join, such as
ACeBabes, or an internet support group
(see page 44).

Making connections Next steps
Some clinics stay in touch during the early weeks of pregnancy and do one or more ultrasound scans to make sure your baby is developing normally. Others do not offer continued care, in which case you will need to make your own arrangements for your antenatal care and birth.
If you are going to have NHS care, the first step is to visit your GP who will arrange a booking visit at the hospital

where you will meet the midwives and doctors who will look after you during your pregnancy. If you are going privately, then you will need to make an appointment with a private consultant.

Finding support
If your treatment is successful, don’t be surprised if you are not as overjoyed as you expected to be. It can take time to adjust and you may go through a rollercoaster of emotions. This is quite normal. The important thing is to accept

38 | For further information visit www.hfea.gov.uk

If you had fertility treatment at a large
NHS hospital with a maternity unit attached (even if you paid privately), or in a large private hospital with a maternity unit, there may be links between the two and your notes can be passed from one to the other so they know your history.
If this is not the case, it will be up to you to tell the doctors and midwives caring for you about your fertility treatment and it’s worth thinking carefully about how much you want to disclose. For example, if you are an older woman but used donor eggs
(ie, from someone under 35) in your treatment, and if your doctors do not know this, they may suggest antenatal tests that are, in your case, unnecessary.

2007/08 | The HFEA guide to Infertility

Checkpoint
Emotionally, you may find being pregnant tough but physically your pregnancy should not be any different to someone who didn’t have fertility treatment. There are some situations which may mean you need more scans or appointments at the hospital. These include: previous miscarriages or stillbirths age - the older you are the greater your risk of complications such as pregnancy diabetes and pre-eclampsia (the high blood pressure condition of pregnancy) expecting twins, triplets or more your general health

Natural concerns
More than a million babies around the world have now been born as a result of assisted conception treatment such as IVF and the chances are you will give birth to a healthy baby. But as well as huge benefits, all medical treatments carry some risks.
There is no way of ruling out the slight chance of problems, no matter how the baby was conceived, and most problems are relatively minor. You may find it hard, but try to relax and enjoy your pregnancy if you possibly can. You have come on a long journey and now you are about to set out on another.

YOU ASK…
Will I be more likely to miscarry after fertility treatment? The average rate of miscarriage following IVF is slightly higher than following natural conception. This is because, firstly, women who have fertility treatment will have a pregnancy test very early on in the pregnancy. A woman who conceived naturally may experience what she considers to be a ‘late period’ when in fact an embryo has been created, but failed to implant. Secondly, the risk of miscarriage rises with the mother’s age. Women who have fertility treatment tend, on average, to be older than those who conceive naturally.

I’ve been told my risk of an ectopic pregnancy is higher because my tubes are blocked or damaged.
What is this?
An ectopic pregnancy is one in which the embryo starts to grow outside the uterus, usually in the fallopian tube, but sometimes in the ovary, cervix or elsewhere in the abdomen. The risk is slightly higher if your tubes are not working properly.
Tell-tale signs to watch out for include pains low down in your stomach and vaginal bleeding. If you do experience either of these, get medical advice immediately. Ultrasound scans and blood tests can help to confirm the diagnosis.

For further information visit www.hfea.gov.uk | 39

The HFEA guide to Infertility | 2007/08

Moving on
SOMETIMES TREATMENT DOESN’T WORK AND YOU MAY NEED TIME TO RECOVER
PHYSICALLY AND EMOTIONALLY BEFORE THINKING ABOUT TRYING AGAIN
After the physical stress of treatment and the build-up of hopes, it can be devastating if your treatment doesn’t work. Many experts recommend that you wait for a couple of months before trying again, which gives you a break from the stress of treatment and a chance for your body to recover.
You may want to talk to your specialist about whether to try again - using the same or a different method - and whether there is anything you can do to boost your chances of conception. Seeing a counsellor can also help you to talk through your feelings.
Remember that, just as in any pregnancy, many embryos are lost early on. Were you not having treatment, you might just think this is a late period, rather than a miscarriage. But when you are having fertility treatment, you’re only too aware that the embryo transferred to your womb has failed to implant and that you have ‘miscarried’.

The reasons why
There are two main reasons why things can go wrong.
1. Treatment may have to be cancelled before the eggs are collected or before the embryos are put back in the womb if:

2. The embryos fail to develop in the womb. This is the most common reason for treatment being unsuccessful. There is often no obvious explanation but one of the following may be the reason:

the ovaries don’t respond to the drugs used to stimulate egg production the ovaries over-respond (ovarian hyper-stimulation) to the drugs used to stimulate egg production no eggs are found during egg collection - for example, if the follicles
(egg sacs) have developed but they are found to be empty the collected eggs don’t fertilise so there are no embryos to be transferred to the womb the embryos fail to develop in the laboratory, so cannot be transferred to the womb.

40 | For further information visit www.hfea.gov.uk

Embryos have a reduced chance of implanting. The egg may not have matured properly in the first place, or may not have divided as it should after fertilisation.
Chromosome problems. Many embryos that look healthy have faulty chromosomes - the structures inside cells that contain genes and control how the cell works and what it does.
New pre-implantation genetic screening (PGS, see page 25) is a technique that can be used to detect some chromosomal problems. This can make it easier for doctors to exclude embryos with such problems, and transfer other embryos instead.
Poor blood flow to the womb. Even if there is nothing wrong with the quality of the embryos, if circulation to the womb is poor, you have less chance of getting pregnant and a greater chance of miscarriage if you do conceive.

Next steps
Whether you have had one or more tries at fertility treatment, sooner or later you may have to decide whether or not to give it up. You may feel you cannot afford more treatment, financially or emotionally, or your specialist may tell you that you have little or no chance of conceiving. Alternatively, you may just feel that enough is enough and you simply want to get on with your life.
It is important that you feel you are making a choice to stop treatment, and that it is not a sign that you have failed, or not done enough. Of course, it need not mean giving up all hope of having children
- you may wish to explore the possibility of other options, such as adopting and fostering. Remember, there are no wrong or right choices, just the one that is right for you. It’s often helpful to talk to a counsellor, or to others who have been in a similar situation, as you come to this decision about how you can best ‘move on’. There is a national organisation, More to Life, which provides support for people who are exploring what life without children has to offer (see page 45).

2007/08 | The HFEA guide to Infertility

The ‘Immunology Question’
A few clinics may suggest immunological treatment. Some experts believe that there is a link between a number of immunological abnormalities and infertility, IVF failure or pregnancy loss.
These are sometimes thought to be related to the level of ‘natural killer cells’ or NK cells.

Such tests and any recommended treatment can be expensive and it is a good idea to discuss the risks and benefits in detail with your clinic. To date, the view of the Royal College of
Obstetricians and Gynaecologists
(RCOG) is that there is not enough available data to justify the blood tests, endometrial biopsies and steroids that

may be involved. The HFEA supports this view and will continue to monitor and review the available evidence for such treatments.
For more information, visit www.hfea.gov.uk/ForPatients and www.rcog.org.uk

Our story: Our decision evolved over about five years
Feelings
‘Although I’m a positive person it was exhausting keeping up a front and I withdrew from a lot of activities. Our decision not to pursue treatment or adoption evolved over about five years.
I can look at it reasonably strongly now but deep down I am still angry at the unfairness of it all.’

Barbara, an IT consultant, had to have an ovary removed as a result of an ovarian cyst, and she also had blocked fallopian tubes. Her husband
Jeremy has low sperm motility.
Despite four attempts at IVF, treatment failed to work and they decided not to carry on.
Barbara tells their story
Treatment time
‘We went private because the NHS waiting lists for treatment were long and we had the funds to pay. After four failed cycles the hospital suggested donor treatment. We decided to give ourselves time to consider this as well as adoption but eventually decided not to pursue treatment.’

Making a complaint If you are not happy with your clinic, or feel things went wrong because of something they did or did not do, you may want to complain. All licensed clinics have a proper complaints procedure and a named person to handle complaints. Minor complaints can often be dealt with on the spot.

‘I told my boss who was understanding, but I didn’t tell anyone else at work and shortly after ending treatment,
I switched jobs - partly I think in retrospect to get away from an environment I associated with loss and stress. My closest friends were sympathetic but regular chats with my mom who lives in Canada were the best support while my mother-in-law gave me the hugs and comfort that I missed from my own mom. My dad didn’t really know what to say and would start talking about my brother’s children as though talking about them would
‘encourage’ me to be successful at IVF!’
Our relationship
‘It put a strain on our relationship especially immediately after we had stopped treatment and before we

Before you decide to make a complaint, you may wish to consider what kind of outcome you are hoping for from the clinic. Do you, for example, want them to: investigate the matter? accept they have made a mistake and apologise to you? take disciplinary action against a member of staff?

were really able to think about moving on. We were both so ‘lost’ that if one of us had made a move to chuck it in the other might not have had the strength to do anything about it. But we stuck it out, stayed close - even without talking about it a huge amount - time marched on, and we both started realising that life is good, although it’s not necessarily what we would have chosen and we are thankful that we have each other.’
Our tips
Take it a step at a time.
Don’t let fear stop you whether it’s to continue with treatment or stop.
Don’t automatically assume that others will understand what you’re going through.
If people say or do something insensitive they aren’t necessarily trying to hurt you. Choose a
‘technique’ for dealing with it, such as silently counting to ten while smiling at them - they’ll get the hint - and in most cases will feel horrified that they’ve hurt you.

reassure you that the same thing will not happen again to another patient? a combination of these actions?

For more information about the process of making a complaint (which differs depending on whether your treatment is NHS funded or whether you are paying for your own treatment), visit www.hfea.gov.uk/ForPatients offer you compensation?

For further information visit www.hfea.gov.uk | 41

The HFEA guide to Infertility | 2007/08

Clinics licensed by the HFEA
( as at 1 March 2007)

For more information about each of these clinics, including the range of services they provide, whether they treat NHS or fee-paying patients and contact details, please go to the
Find A Clinic section of our website: www.hfea.gov.uk/ForPatients

Scotland
1
2
3

Aberdeen Fertility Centre
Ninewells Hospital, Dundee
Lanarkshire Acute Hospital NHS
Trust, Airdrie
4 Edinburgh Assisted Conception Unit
5 Glasgow Nuffield Hospital
6 Glasgow Royal Infirmary
84 Glasgow Centre for Reproductive
Medicine

England

(by region)

North East
7 Newcastle Fertility Centre at Life
8 Centre for Assisted Reproduction,
Gateshead
9 Sunderland Fertility Centre
10 Hartlepool General Hospital
11 Bishop Auckland General Hospital
12 London Women’s Clinic, Darlington
13 Cleveland Gynaecology and Fertility
Centre, Middlesbrough
14 The James Cook University Hospital,
Middlesbrough
North West
15 St Mary’s Hospital, Manchester
16 CARE Manchester
17 Manchester Fertility Services
18 Hewitt Centre for Reproductive
Medicine, Liverpool Women’s Hospital
Yorkshire and the Humber
19 ACU Leeds
20 Clarendon Wing, Leeds General
Infirmary
21 Hull IVF Unit
22 CARE Sheffield
23 Centre for Reproductive Medicine,
Sheffield
East Midlands
24 Queens Medical Centre Fertility Unit,
Nottingham
25 NURTURE, Nottingham
26 CARE Nottingham
27 Derby City General Hospital
28 Leicester Fertility Centre
29 CARE Northampton

West Midlands
30 Burton Hospitals NHS Trust, Burton upon Trent
31 Shropshire and Mid-Wales Fertility
Centre, Shrewsbury
32 St Jude’s Women’s Hospital,
Wolverhampton
33 BMI Priory Hospital, Birmingham
34 Midland Fertility Services, Aldridge
35 Birmingham Women’s Hospital
36 Centre for Reproductive Medicine,
Coventry
East
37 The Fertility Unit, Peterborough
District Hospital
38 The Rosie Hospital, Cambridge
39 Bourn Hall Clinic, Cambridge
40 Isis Fertility Centre, Colchester
41 Brentwood Fertility Centre
42 Essex Fertility Centre, Buckhurst Hill
Greater London
43 London Female and Male Fertility
Centre, Highgate
44 Homerton University Hospital,
Hackney
45 CRM London, Marylebone
46 Reproductive Medicine Unit,
UCL Hospital NHS Trust, Holborn
47 North East London Fertility Services,
Ilford
48 UCH London, Camden
49 IVF Hammersmith, Acton
50 Assisted Reproduction and
Gynaecology Centre, Marylebone
51 The Centre for Reproductive
Medicine, Barts and the London
53 The Lister Fertility Clinic, Chelsea
54 London Women’s Clinic, Marylebone
55 The Harley Street Fertility Centre,
Marylebone
56 Cromwell IVF and Fertility Centre,
Chelsea
57 London Fertility Centre, Marylebone
58 Chelsea and Westminster Hospital,
Fulham
59 The Bridge Centre, London Bridge
60 Guy’s Hospital, Waterloo

42 | For further information visit www.hfea.gov.uk

Greater London (cont)
61 ACU King’s College Hospital,
Camberwell
62 Queen Mary’s Hospital, Sidcup
63 Shirley Oaks Hospital, Croydon
64 BMI Chelsfield Park ACU, Orpington
South East
65 Oxford Fertility Unit
66 BMI The Chiltern Hospital Fertility
Services Unit, Great Missenden
67 The Woking Nuffield Hospital
68 BMI The Chaucer Hospital,
Canterbury
70 Wessex Fertility Limited,
Southampton
71 The Princess Anne Hospital Fertility
Unit, Southampton
72 BMI The Esperance Hospital, Sussex
Downs Fertility Centre
85 South East Fertility Unit, Tunbridge
Wells
86 The Agora Gynaecology and Fertility
Centre
South West
73 Southmead Hospital, Bristol
74 Centre for Reproductive Medicine,
University of Bristol
75 Bath Assisted Conception Clinic
76 Salisbury Fertility Centre
77 Peninsular Centre for Reproductive
Medicine, Exeter
78 BMI The Winterbourne Hospital,
Dorchester
79 South West Centre for Reproductive
Medicine, Plymouth

Wales
80 London Women’s Clinic, Swansea
81 Cardiff Assisted Reproduction Unit

Northern Ireland
82 Regional Fertility Centre, Belfast
83 Origins Fertility Care, Belfast

2007/08 | The HFEA guide to Infertility

1

2

Scotland

84 3
5
6

Greater
London

4

43
44
46
48
50
51
49
53
54 55
56 57
58
60 59
61
45

47

62
63

64

7
8
North 9
East
10
11

Northern
Ireland 82
83

12
14 13

North
West

Yorkshire and the Humber
19
20

18

15 16
17

21

23
22
24
25
26
27

31

32
33

30

34
35

28

37

36
38
39

29

West
Midlands

Wales

East
Midlands

East
40

41
42

65 66

80
81
73
74

London
75

South West
77

67
85
76

70

71

South
East

68

72
86

78

79

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The HFEA guide to Infertility | 2007/08

Useful contacts

ACeBabes
ACeBabes offers support on pregnancy following fertility treatment, multiple births, donor conception for donors and recipients, decisions surrounding frozen embryos, trying for siblings, deciding to end treatment, and telling children how they were conceived.
Provides a quarterly newsletter, sub-group news sheets, meetings, personal contacts for specific conditions and an interactive website.
Tel: [phone]
Website: www.acebabes.co.uk

British Infertility Counselling
Association (BICA)
BICA aims to promote high quality, accessible counselling services for those with fertility problems. It offers information to patients seeking details of counsellors specialising in infertility.
Tel: [phone]
Website: www.bica.net

Cancerbackup
This charity offers independent, accessible information, practical advice and support for people affected by cancer. Its range of information booklets includes how cancer treatments can affect fertility (and the future fertility of teenage patients).

Child Bereavement Trust
This charity’s philosophy is based on learning from families who have experienced the death of a baby or child or from children who have experienced the death of their mother, father, brother or sister.
Tel: [phone]
Website: www.childbereavement.org.uk

Childlessness Overcome Through
Surrogacy (COTS)
The main objective of COTS is to pass on collective experience to surrogates and would-be parents, helping them to understand the implications of surrogacy. Tel: [phone]
Website: www.surrogacy.org.uk

Donor Conception Network
(DC Network)
DC Network provides contact and support for people who have children conceived, or who plan family creation, using donated gametes through donor insemination (DI) and IVF with donor sperm or donated eggs. Also provides support for adult offspring of donor conception.
Tel: [phone]
Website: www.dcnetwork.org

Genetic Interest Group (GIG)
A national alliance of patient organisations with a membership of over
130 charities which support children, families and individuals affected by genetic disorders.
Tel: [phone]
Website: www.gig.org.uk

Daisy Network Premature
Menopause Support Group
Daisy Network provides support and information for women who have gone through an early menopause. Members can speak to others who have been through egg donation cycles, both successfully and unsuccessfully. Also publishes factsheets and a quarterly newsletter and has an annual conference. Tel: [phone]
Website: www.daisynetwork.org.uk

Tel: [phone]
Website: www.cancerbackup.org.uk

44 | For further information visit www.hfea.gov.uk

Infertility Network UK (I N UK)
I N UK provides practical and emotional support to those experiencing difficulties in conceiving whatever stage of their journey they are at. There is a regional network and local support groups, and the charity also produces factsheets and other information, including a video.
They have a telephone advice line, medical advisers and a website with news, forums and information.
Tel: [phone]
Website: www.infertilitynetworkuk.com

2007/08 | The HFEA guide to Infertility

Miscarriage Association
The Association provides support and information on pregnancy loss.
Tel: [phone]
Website:
www.miscarriageassociation.org.uk
More to Life
A national support network providing a support service for people exploring what life without children has to offer - both involuntary childlessness, and those for whom fertility treatment is no longer a consideration. Tel: [phone]
Multiple Births Foundation
The Multiple Births Foundation provides professional support and information about all aspects of multiple births.
Tel: [phone]
Website: www.multiplebirths.org.uk
National Childbirth Trust (NCT)
The NCT helps parents to have an enriching experience of pregnancy, birth and early parenthood, providing local support and contacts for social networking. It runs antenatal classes and provides information on maternity issues, breastfeeding and postnatal support, including specialist groups for Caesareans and miscarriage.
Tel: [phone]
Website:
www.nctpregnancyandbabycare.com
Endometriosis UK
The Society provides a helpline, local groups and clubs, a newsletter and other publications, workshops and conferences.
Tel: [phone]
Website: www.endo.org.uk
National Gamete Donation Trust
(NGDT)
The NGDT was founded as a registered charity in April 1998 in order to raise awareness of, and seek ways to alleviate, the shortage of sperm, egg and embryo donors in the UK. The NGDT is a central reference point for donors, recipients and health professionals.
Tel: [phone]
Website: www.ngdt.co.uk

National Institute for
Clinical Excellence (NICE)
NICE is part of the NHS. It is the independent organisation responsible for helping patients, health professionals and the public to make decisions about treatment and healthcare.

Surrogacy UK
A website and message board providing advice on surrogacy in the UK. It was set up by Elizabeth Stringer and Carol O’Reilly, who have been involved in surrogacy since
1994.
Tel: [phone] (10am-2pm)
Website: www.surrogacyuk.org

Tel: [phone]
Website: www.nice.org.uk

Twins and Multiple Births Association
(TAMBA)
TAMBA provides support for families with twins, triplets or more, and for professionals involved with their care. It has a network of local twins clubs and specialist support groups, and provides publications and information packs.

Pink Parents UK
Pink Parents’ services to lesbian, gay, bisexual and transgendered families includes information and support to those who would like to have children.
Tel: [phone]
Website: www.pinkparents.org.uk

Tel: [phone]
Website: www.tamba.org.uk
Project Group on Assisted
Reproduction (PROGAR)
PROGAR campaigns in two main areas: for the right of people with fertility difficulties to informed choice and quality of care, including counselling; and for the right of people to have access to identifying information about their genetic origin.
Tel: [phone]
Website: www.basw.co.uk/progar

Progress Educational Trust (PET)
This UK charity provides information and debate on assisted reproduction and human genetics, promoting discussion among patients, the wider public and professionals on their social, legal and ethical implications. PET holds regular public debates and conferences and produces a free web and email news and comment service, BioNews, with support from the Department of Health.

UK Donorlink
A pilot voluntary contact register set up to enable people conceived through donated sperm and/or eggs, their donors and halfsiblings to exchange information and where desired - to contact each other. The register is for anyone over 18 who was conceived with donated sperm or eggs, or who donated in the UK before the Human
Fertilisation and Embryology
Act came into force in August 1991.
Tel: [phone]
Website: www.ukdonorlink.org.uk

Verity
Verity is a self-help organisation for women affected by polycystic ovary syndrome
(PCOS) and is dedicated to improving the lives of sufferers.
Website: www.verity-pcos.org.uk

Tel: [phone]
Website: www.progress.org.uk

Stillbirth and Neonatal Death Society
(SANDS)
SANDS provides support for parents and families whose baby is stillborn or dies soon after birth.
Tel: [phone]
Website: www.uk-sands.org

Useful websites
There are many websites that provide information about infertility and opportunities to ask questions and exchange personal experiences with others. A few that patients have mentioned to us are: www.fertilityfriends.co.uk www.may-b-baby.co.uk www.gettingpregnant.co.uk www.ivf-infertility.com www.singlemother.typepad.com www.ivfworld.com
Let us know of others you find helpful.

The HFEA cannot vouch for the information supplied by other organisations mentioned in this Guide.
Nor does the inclusion of such organisations’ details in the Guide imply any endorsement by the HFEA.

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2007/08 | The HFEA guide to Infertility

Glossary
Abandoned Cycle:
An IVF treatment cycle cancelled after drug administration has begun but before egg collection.
Amniocentesis: Withdrawal of amniotic fluid from the amniotic sac containing the foetus, usually between week 14 and 18 of pregnancy. Genetic diseases of the foetus can be revealed by tests on this fluid and the foetal cells it contains. Amnion: The inner membrane of the sac in which the embryo develops.

Chlamydia: A sexually transmitted disease which may remain undetected for a long time. It may damage female and male reproductive systems, causing infertility. Chorion: The outer membrane tissue of the primitive placenta.
Chorion villus sampling (CVS):
Removing a small amount (biopsy) of placental chorionic villi for genetic analysis, usually between week 8 and
12 of pregnancy.

Amniotic fluid: The fluid filling the cavity between the embryo and the amnion. Chromosome: Threadlike structure of
DNA with associated proteins located in the cell nucleus, containing genes which carry genetic information.

Assisted hatching: Mechanical, laser or chemical breaching of the zona pellucida (outer layer) of the egg.

Cleavage: The division of the zygote
(cell formed by fertilisation) to produce a blastocyst.

Assisted Reproductive Technologies
(ARTs): Collective name for all artificial techniques used to assist women to conceive children, including IVF and
ICSI.

Clomid: A drug used in stimulated DI and IUI cycles.

Asthenozoospermia: A below normal number of sperm in the male ejaculate. Congenital malformations: Any malformation seen at birth, either resulting from genetic (inherited) or environmental causes.

Azoospermia: The complete absence of sperm in male ejaculate.
Blastocyst: An embryo that has developed for five to six days after fertilisation. Blastomere: A cell taken (by biopsy) from a blastocyst.
Cell: The basic unit of all living organisms. Complex organisms such as humans are composed of somatic
(body) cells and germ line
(reproductive) cells.
Cervical mucus: Secretions surrounding the cervical canal, which during ovulation, alter in amount and texture to allow sperm penetration.
Cervix: The narrow passage at the lower end of the uterus (womb), connecting to the vagina.

46 | For further information visit www.hfea.gov.uk

Clomiphene: A fertility drug used to stimulate the production of follicles.

Counselling: Discussions aimed at giving emotional support to help patients understand and cope with the consequences of infertility treatment. Cryopreservation: The storage of gametes or embryos by freezing at low temperatures.
Cytomegalovirus (CMV): A member of the herpes groups of viruses. Most adults and children who catch CMV have no symptoms, although some people may get a fever, sore throat, fatigue and swollen glands. CMV is of most risk to unborn children of women who get CMV for the first time during pregnancy. About 7 to
10% of these babies will have symptoms at birth or will develop disabilities including mental retardation, small head size, hearing loss, and delays in development.

DeoxyriboNucleicAcid (DNA): The major constituent of chromosomes, and the hereditary material of all living organisms. Dizygotic: Derived from two (di) eggs
(zygote). Dizygotic twins form when two separate eggs are fertilised by separate sperm.
Donor: Person who allows their gametes or embryos to be used for fertility treatment or research purposes. Although the genetic parents of children created using their gametes, donors are not the legal parents when treatment was provided in a UK licensed clinic.
Donor Insemination (DI): The introduction of donor sperm into the vagina, the cervix or womb itself.
Egg or oocyte: The gamete produced by a woman during her monthly cycle. Egg collection or egg retrieval:
Collection of eggs from a woman’s ovary using an ultrasound guided needle, or a laparoscope (a fibreoptic telescope used for looking into the abdomen) and needle.
Egg donation: Donation of eggs by a fertile woman for the treatment of others or for research.
Egg sharing: An arrangement with a clinic to reduce IVF treatment costs, where a woman undergoes a treatment cycle, donates some of her eggs, but uses some herself.
Embryo: A fertilised egg that has the potential to develop into a foetus.
Embryo biopsy: The removal and culture of one or two cells from an embryo in vitro prior to genetic screening. Embryo division: Splitting of an embryo grown in vitro, at a very early stage, into two or more sections.
Each section can be grown separately producing multiple clones
(fission cloning) of the single original embryo. The HFEA guide to Infertility | 2007/08

Embryo freezing and embryo storage:
Spare embryos can be frozen
(cryopreservation) and stored for future use.
Embryo transfer: The replacement of embryos back into the female patient. Endometriosis: A female condition in which endometrial cells, which normally line the uterus, implant around the outside of the uterus and/or ovaries, causing internal bleeding, pain and reduced fertility.
Endometrium: The lining of the womb which grows and sheds during a normal menstrual cycle and which supports a foetus if a pregnancy occurs. Epididymis: A highly convoluted tube about seven metres long connecting the testes to the vas deferens. Sperm moves along the tube and is stored in the lower part until ejaculation.
Fallopian tube(s): The pair of tubes which lead from the ovaries to the uterus (womb). After an egg is released from one of the ovaries, it is transported through a Fallopian tube to the uterus. The tubes are the site of fertilisation in natural conception.
Fertilisation: The penetration of an egg by a sperm resulting in the formation of an embryo. Naturally fertilisation occurs in the woman’s body (in vivo), but it can also occur in the laboratory (in vitro).
Fibroid: A ball of fibrous muscular tissue which may grow in the muscular wall of the uterus. This can cause pain and excessive menstrual bleeding and result in impaired fertility. Flow cytometry (sperm sorting): A method of sperm sorting used for sex selection. X and Y chromosomebearing sperm are stained with different fluorescent dyes, and can then be sorted by colour
Foetus: The term used for an embryo after the eighth week of development until birth.

Follicle(s): A small sac in the ovary in which the egg develops.

HFEA: Human Fertilisation and
Embryology Authority.

Follicle-stimulating Hormone (FSH): A pituitary hormone which stimulates the follicle production by the ovary.
Often administered in assisted conception to stimulate production of several follicles (ovulation induction).

Hysterectomy: The surgical removal of the uterus (womb).

Gamete: The male sperm or female egg which fuse together to form a zygote. Implantation: Where an embryo embeds itself in the uterus lining, after passage through the Fallopian tubes. Gamete Intrafallopian Transfer (GIFT):
A procedure in which eggs are retrieved from a woman, mixed with sperm and immediately replaced into one of the woman’s Fallopian tubes, so fertilisation occurs inside the body
(in vivo).
Gene: The unit of inheritance.
Everyone inherits two copies of each gene. A dominantly inherited genetic disease occurs when only one copy of the gene is sufficient to produce the disease e.g. Huntington’s chorea.
A recessively inherited disease only occurs if both copies of the defective gene are present e.g. Tay-Sachs’ disease, Sickle cell disease.

Hysterosalpingogram: An x-ray of the
Fallopian tubes, through which dye is passed, to see if they are obstructed.

Impotence: Term for a man’s inability to perform sexual intercourse or gain an erection.
Inner cell mass: A clump of cells growing within and to one side of the blastocyst from which the embryo develops. Insemination: The artificial placing of freshly ejaculated or frozen sperm in the female reproductive tract.
Intra-cytoplasmic Sperm Injection
(ICSI): Where a single sperm is directly injected into the egg.
Intra-uterine Insemination (IUI):
Insemination of sperm into the uterus of a woman.

Genome: The basic set of genes in the chromosomes in any cell, organism or species.
Gonadotrophin Releasing Hormone
(GnRH): Hormone released by the hypothalamus which stimulates the pituitary to produce Luteinising
Hormone (LH) and Follicle-stimulating
Hormone (FSH).
Gonadotrophins: Drugs used to stimulate the ovaries similar to GnRH.
Gradient sperm sorting methods:
Way of sorting X and Y chromosomes containing sperm, for sex selection.

Intra Vaginal culture (IVC): A method of incubating sperm and aspirated oocytes together in a container held in a woman’s vagina, allowing in vitro fertilisation without using complex laboratory facilities.
In Vitro Fertilisation (IVF): Human eggs and sperm mixed together in a laboratory to achieve fertilization outside the body. The embryos produced may then be transferred into a female patient.
In vitro: Performed outside the body
(i.e. in the laboratory).

Human Chorionic Gonadotrophin
(HCG): A protein hormone usually secreted by the chorionic villi of the placenta. Its presence in the maternal blood or urine indicates pregnancy.
HFE Act: The Human Fertilisation and
Embryology Act 1990.

In vivo: Performed in the body.
Karyotype: The microscopic appearance of a set of chromosomes, including their number, shape and size.

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2007/08 | The HFEA guide to Infertility

Glossary
Laparoscopy: Examination of the pelvic or other abdominal organs with a fibreoptic telescope inserted surgically below the naval. During laparoscopy, suction applied to the needle can be used to recover eggs from follicles in the ovary.
Licence: A legal document stipulating terms and conditions for which a centre may carry out a licensable fertility treatment at a specified premise. Live birth rate: The number of live births achieved from every 100 treatment cycles started.
Luteinising Hormone (LH): Hormone released by the pituitary gland in response to Gonadotrophin
Releasing Hormone (GnRH) production. Essential for development of eggs and sperm.
Menstrual period/Menstruation: The monthly bleed which takes place if no pregnancy occurs, caused by the sloughing off of the womb’s lining.
Menstrual cycle: A woman’s monthly cycle where the egg is released from an ovary, the uterus develops and finally blood and tissue are lost via the vagina if a pregnancy does not occur. Microsurgical Epididymal Sperm
Aspiration (MESA): Extracting relatively mature sperm from the epididymis using a small needle.
Monozygotic: Meaning single (mono) egg (zygote). Monozygotic twins form when one fertilised ovum separates into two identical zygotes.
Morula: The ball of cells forming about 3 - 4 days after the cleavage of the fertilised ovum.
Multiple birth: When a multiple pregnancy actually results in the birth of two or more babies.
Multiple birth rate: The percentage of all births in which more than one baby was born.
Multiple pregnancy: A pregnancy where two or more foetuses develop at one time in the uterus (womb).

Neonatal death: The death of a baby within 28 complete days of delivery.
Nucleus: The part of a cell which contains the genetic material, DNA.
Oestrogen/Oestradiol: Female sex hormone produced by the ovary.
Levels fluctuate during the menstrual cycle. Oligozoospermia: Low sperm count.
Less than twenty million sperm per millilitre. Severe if less than five million sperm per millilitre.
Oocyte: The female gamete (egg).
Ovary: The female reproductive organ producing oocytes from hormonestimulated germ cells.
Ovarian Hyperstimulation Syndrome
(OHSS): A serious complication following stimulation of the ovaries with gonadotrophin drugs.
Ovulation: The release of an egg from a follicle in the ovary.
Ovum: The female gamete (egg).
Partial Zona Dissection (PZD): In conjunction with IVF, making a small hole in the egg’s gelatinous coating, with a small glass needle, to assist sperm to reach the outer egg membrane. Percutaneous Epididymal Sperm
Aspiration (PESA): A technique for sperm recovery. A fine needle is passed into either the epididymal region of the testes, or the coiled tubing outside the testicles that stores sperm (epididymis), and sperm recovered by gentle suction.
Peritoneal cavity: The cavity of the abdomen where the Fallopian tubes and the uterus are situated.
Perinatal Mortality Rate: Perinatal mortality is the total number of foetal deaths and neonatal deaths.
Pituitary: Gland in the brain which produces many hormones including
Follicle-stimulating Hormone (FSH) and Luteinising Hormone (LH).

48 | For further information visit www.hfea.gov.uk

Polycystic Ovarian Syndrome:
Condition where many small cysts form on the ovary, resulting in hormonal imbalances which can cause infertility. Treatment involves drugs or surgery.
Polymerase Chain Reaction: A process used in DNA analysis.
Pregnancy rate: The number of pregnancies achieved from every 100 treatment cycles commenced.
Preimplantation Genetic Diagnosis
(PGD): The removal of one or two cells from an embryo to test for specific genetic disorders/ characteristics prior to embryo transfer. Preimplantation Genetic Screening for Aneuploidy (PGS): The removal of one or two cells from an embryo, for testing to ensure the chromosome number is correct (euploidy) and not more or less than usual (aneuploidy).
Primitive streak: Thickening in surface of embryos which results in the first clearly recognisable stage in embryonic development.
Profasi: Purified Human Chorionic
Gonadotrophin used in assisted conception to mature follicles and cause ovulation to occur.
Progesterone: Hormone produced by both the ovary and corpus luteum after ovulation encouraging the growth of the lining of the womb.
Prostate Gland: A gland which secretes an alkali solution upon ejaculation making up a major part of the ejaculate.
Selective reduction: The procedure in which one or more normal foetuses in a multiple pregnancy resulting from assisted conception are destroyed.
The procedure may be hazardous to the remaining foetus(es).
Seminiferous tubules: Very long and convoluted tubules which make up the bulk of the testicles. It is here that sperm is produced.

The HFEA guide to Infertility | 2007/08

Sex selection: The sex of an embryo is determined using PGD, in order to avoid sexlinked diseases.
Sperm: Male gametes (or mature male germ cells). Of the millions of sperm present in the ejaculate roughly half carry X chromosomes, and half Y chromosomes. A single sperm is called a spermatozoon.
Sperm sorting: The separation of sperm carrying X chromosomes from those carrying Y chromosomes prior to fertilisation, in order to determine the sex of the offspring. Used for sex selection. Testicular Sperm Extraction (TESE):
Sperm extraction technique involves exposing testicular tissue through a small cut in the scrotum and the removal of a small piece of testicular tissue. Welfare of the child: The social and ethical considerations used when considering the well-being of an individual under the age of 18.
Zona drilling: The use of chemicals to dissolve the gelatinous coating of the egg leaving a hole through which the sperm can enter.

Testis: Testicle or male gonad.
Transvaginal aspiration: A method of egg recovery in which a needle is inserted through the top of the vagina into the ovary lining.

Spermatid: An immature sperm cell.

Transvaginal oocyte recovery: The female bladder is emptied and a needle passed through the vagina using ultrasound guidance in order to recover eggs.

Stem cell: Reproduce indefinitely and have the capacity to develop
(differentiate) into a large number of different cell types.

Treatment cycle: One complete licensed treatment. Commences with drug administration or first insemination. Stillbirth: The birth of a dead infant.
Stimulated cycle: A treatment cycle in which stimulation drugs are used to produce more eggs than usual in the woman’s monthly cycle.

Trisomy: A syndrome reflecting the presence of three chromosomes of one type instead of the normal number of two. An example is
Trisomy 21 resulting in Down’s syndrome. Stimulation drugs: Stimulate a woman’s ovaries to produce more eggs than usual in a monthly cycle.
Also known as superovulatory drugs.

Ultrasound: High frequency sound waves used to provide images of tissues, organs and other internal bodily structures.

Subzonal sperm insertion (SUZI): A technique whereby one or several sperm are injected directly through the zona pellucida (outer layer) of the oocyte. Ultrasound-guided aspiration: A nonsurgical, noninvasive method of egg recovery using ultrasound images to guide the path of the oocyte recovery needle. Superovulation/stimulation: The medical stimulation of the ovary with hormones to induce the production of multiple egg-containing follicles in a single menstrual cycle.

Zona Pellucida: The transparent membrane or shell surrounding the oocyte (egg).

Unstimulated cycle: A natural cycle where no drugs are given to stimulate egg production.

Swim up: Technique for separating sperm, based on their ability to swim through a liquid.
Teratozoospermia: Poor sperm morphology (shape) which causes infertility. Testicular Sperm Aspiration (TESA):
Sperm extraction technique which inserts a needle into the lower region of the testes to remove a small piece of testicular tissue.

Zygote: The cell formed as a result of fertilisation. Zygote Intra-fallopian Transfer (ZIFT):
The transfer of embryos to the
Fallopian tubes for purposes of achieving a pregnancy. Embryos are transferred at the fertilised egg (one cell embryo) stage.

Uterus: The female womb in which the embryo develops.
Varicocele: A varicose vein on the testicles. These may cause testicle overheating and be detrimental to sperm production.
Vas Deferens: Pair of tubes which connect the epididymis to the urethra and transport sperm during ejaculation. For further information visit www.hfea.gov.uk | 49

The HFEA guide to Infertility | 2007/08

Ask the clinic
THE FIRST CONSULTATION WITH A DOCTOR OR CLINIC CAN SOMETIMES BE
CONFUSING OR DIFFICULT. DO REMEMBER THAT CLINIC STAFF ARE THERE
TO HELP YOU AND WILL BE HAPPY TO DISCUSS YOUR QUESTIONS AND
CONCERNS WITH YOU. IT’S VITAL THAT YOU FEEL FULLY INFORMED ABOUT,
AND COMFORTABLE WITH, THE RECOMMENDED TREATMENT
Some patients find it helpful to keep a diary of clinic appointments, cycle dates and other information, such as notes from your consultations and questions that arise in between appointments which you would like to raise next time.

There are many issues raised throughout this
Guide and you have probably also received a lot of information from friends, doctors and the internet.
We’ve listed some of the questions here that you may also want to ask when you visit your clinic, to help you make the most of your consultation.

What are the benefits of the treatment you’ve recommended and why do you think it’s the best option for me?

Can you break down all the costs involved in this treatment? Are there any other costs that might arise?

How many patients at your clinic have had this treatment in the last two years, and how many of them have become pregnant/had a baby?

What lifestyle changes can I make to boost my chance of success (eg, diet, exercise, stopping smoking, etc)?
How will these help?

Are there alternative treatments? If so, what do they involve, and why do you think they are less suitable for me?

What kind of counselling or advice service do you provide? Is there a cost for this, or how many free sessions can I have?

What other options are available to me if this treatment doesn’t work?

Does this clinic have a patient support group I can join, or are there other groups you would recommend?

How does my age affect the choice of fertility treatment? What drugs will I have to take, and what are the usual side effects they might have?

Could you tell me more about the assessment process you will need to carry out before giving me the go-ahead for treatment (this is sometimes known as the ‘welfare of the child’ assessment)?

Are there any alternatives to the drugs you have mentioned? What happens next? Do I (and/or my partner) need to do anything now?

50 | For further information visit www.hfea.gov.uk

Is there any way these costs can be reduced?

2007/08 | The HFEA guide to Infertility

Acknowledgements
The HFEA would like to thank the following individuals and organisations for their time and help in compiling the information in this year's HFEA Guide to Infertility:
Clare Brown, Chief Executive, Infertility Network UK
Jennifer Hunt, Senior Infertility Counsellor, Hammersmith Hospital
Dr Maybeth Jamieson, Consultant Embryologist, Glasgow Royal Infirmary
Walter Merricks, Co-founder of the Donor Conception Network
Susan Seenan, Communications Officer, Infertility Network UK
Jane Garton and Patsy Westcott for text
Tangerine for design
Our thanks also to the many patients, past and present, who have provided helpful comments and suggestions.
Above all, we would like to thank those who have been willing to talk about their personal experience of treatment in this Guide, and to share what they have learned to help others.

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