The information below will help you to understand your appointments and give you important information about preparing for pregnancy and fertility treatment.
First appointment – video
Your first appointment at the clinic will be a 30-minute video appointment with a fertility nurse specialist. The nurse will discuss your medical history and arrange appropriate investigations to help us understand your fertility issues.
We take pride in providing personalised care for our patients and hence this appointment is very important for us to know you. If you have a partner, you should both attend this appointment.
Occasionally, some patients will be discharged after this appointment if no investigations or treatments are needed, if they are not eligible for NHS funded fertility treatment or if they prefer not to proceed any further.
Welfare of the child assessment
All patients attending the fertility clinic are assessed for their ability to care for a child should they become pregnant. If you are a couple we will assess you both.
We will write to your GP to ask if there are any concerns within your medical record that may affect your ability to raise a child.
It is important that you are open and honest with us about your history. Any information disclosed will not always result in the refusal of treatment but will allow us to discuss any issues raised with you further.
Concerns may include:
- Significant mental or physical health problems
- Previous criminal convictions/sexual offences
- Social service involvement/child protection plans
- Domestic violence
- Drug or alcohol abuse
Investigation appointment
Following the video appointment patients who require investigations will receive an appointment to attend the clinic for investigations. The common investigations are detailed below. The nurse will explain which investigations are relevant to you.
Tests you may have
Hormone test
Women are born with all their eggs and as they get older there is a reduction in the number of eggs left in the ovaries. The decline in number is more rapid for women aged 35 and over.
Testing for the level of anti-mullerian hormone helps us to understand a woman’s ovarian reserve. The AMH level is helpful in predicting success from fertility treatment such as IVF, but it does not tell us about the chance of a natural pregnancy.
Full blood count
A full blood count tests haemoglobin levels and identifies if iron supplements are required before pregnancy.
Thyroid hormone
An under or overactive thyroid can impact the chance of a successful pregnancy. All women planning pregnancy will have their thyroid levels checked to see if any additional testing or medication is required.
Vaginal swab and hysterosalpingogram (HSG)
A HSG is an x-ray of the fallopian tubes which checks they are not blocked in any way. The x-ray is done at the RVI. A vaginal swab must be carried out (to rule out infection such as chlamydia or gonorrhoea) before the HSG can be arranged.
Not everyone will require a HSG, the nurse will explain if it is relevant to you.
Semen analysis
Men will need a semen analysis. Your GP may have already organised this for you. In some cases, a repeat semen analysis is needed to help understand the fertility issue.
The semen analysis includes an evaluation of the number, movement and shape of sperm. Men should not ejaculate for 2-5 days before the semen analysis appointment.
Male factor blood tests
Men with a very low sperm count (less than 5 million) or no sperm (azoospermia) will have additional blood tests to try to identify a cause for their sperm problem. The tests include genetic and hormone tests. The nurse might also refer you to our male fertility specialist for further advice and examination.
Viral screening
Female and male atients who are planning fertility treatment will be checked for HIV, Hepatitis B and Hepatitis C.
Haemoglobinopathy screening
Hemoglobinopathies are disorders that affects the structure or production of haemoglobin, the protein responsible for carrying oxygen around the body. Some ethnicities are more at risk of haemoglobinopathy disorders so will be tested prior to planning a pregnancy.
Additional tests
Occasionally additional tests not listed above are required. The team will discuss this with you and explain the purpose of the test.
Investigation results
When your results are available, we will arrange a review appointment with our nurse consultant or one of our doctors to explain your results and plan treatment if appropriate. Some results may take up to 12 weeks to be available.
Discussion of results alongside exploring your personal medical history can be complex, so we cannot to this by email or telephone before the review appointment.
Review appointment
This will be a face-to-face appointment at the fertility clinic.
The nurse consultant or doctor will explain your test results and discuss if any fertility treatment is needed.
Some patients will also have a transvaginal ultrasound scan at this appointment.
Transvaginal ultrasound scan
The purpose of this scan is to identify any problems with your ovaries or uterus. A narrow probe is inserted into the vagina. The scan should not be uncomfortable and can be performed at any time in the menstrual cycle.
Most scans show normal anatomy but sometimes we detect issues such as signs of endometriosis, adenomyosis, endometrial polyps, ovarian cysts or fibroids.
Your scan results will be discussed with you to explain any findings.
Eligibility for treatment on the NHS
Unfortunately, not everyone is eligible for NHS-funded fertility investigation and/or treatment.
Local integrated care boards (ICB) set out the funding criteria for clinics to follow. You can contact the North East and North Cumbria Integrated Care Board for a copy of their policy.
There is no NHS-funded fertility treatment for people who have a living child or whose partner has a living child, but they might be eligible for fertility investigations.
Single women or same sex couples are usually not eligible for NHS-funded fertility investigations or fertility treatment.
Patients who have previously had successful fertility treatment and are returning to try for a sibling are not eligible to NHS-funded fertility investigations or fertility treatment.
Women aged 40-42 must meet certain criteria to be eligible for NHS- funded fertility treatment .
Men or women who have been previously sterilised are not eligible for NHS fertility investigations or treatment.
You can view our current costs for private fertility treatment here.
Preparation for pregnancy
There are a number of things you should be aware of when planning a pregnancy. Please read the information below carefully and discuss any concerns with your GP or with us at your first appointment.
Folic acid
All women who are trying to conceive are advised to take folic acid 400micrograms daily to reduce the risk of a baby born with spina bifida. It is often cheaper to buy this over the counter at a chemist than on prescription. In some situations, if there is a personal or family history of spina bifida or when the woman is taking some medications e.g. some antiepileptic drugs, it is advisable to take a higher dose. If you are uncertain about this, please don’t hesitate to ask.
Vitamins
Vitamin D helps us to absorb the right amount of calcium and phosphate. This is particularly important in pregnancy as it helps to develop baby’s teeth, bones, heart and nervous system.
In the UK, approximately 1 in 5 people have a deficiency in vitamin D. This is especially common in Asian women. Women who are obese also tend to have lower levels of vitamin D.
Low levels of vitamin D may affect reproductive health and may increase the risks associated of pregnancy. You are advised to take a 10micrograms vitamin D supplement when trying to conceive.
Warning
Do not take vitamin A (retinol) supplements, as these can harm your baby.
Alcohol
Heavy drinking reduces fertility in men and women.
If you are pregnant or planning to become pregnant, the safest approach is not to drink alcohol at all to keep risks to your baby to a minimum.
There is no completely safe level of drinking, but sticking within the guidelines lowers your risk of harming your health. Men and women are advised not to regularly drink more than 14 units a week.
Smoking
Research suggests that women who smoke are less likely to conceive following IVF treatment. There is also good evidence that smoking reduces the quality of sperm.
There are well-known health benefits in stopping smoking. Both men and women are strongly advised to stop smoking before embarking on fertility treatment. Women and men seeking NHS funded fertility treatment must be non-smokers.
If you would like help to stop smoking please speak to your GP or pharmacist who can offer you advice or telephone the NHS Smoking Helpline 0300 1231044.
Weight
It is important for both partners to maintain a healthy BMI. Your BMI is your body mass index and is calculated from your weight and your height. An ideal BMI is in the 19 to 25 range. A BMI of 25-30 is overweight and over 30 is obese. You can use the NHS BMI calculator to work out your BMI.
IVF treatment is only available to women with a BMI of less than 30.
We will not offer any type of fertility treatment (NHS or self-funded) to women with a BMI above 35.
For women: if your BMI is over 30, it can take longer to conceive. Losing 5-10% of your body weight can lead to significant health benefits and increase your chances of getting pregnant and it will also reduce the risks in pregnancy. Joining a slimming group may improve your chance of successfully losing weight. The potential health risks of being obese include difficulties during pregnancy, labour and delivery.
For women: if your BMI is less than 19; this may interfere with your periods and fertility, if this applies to you we may advise you that you would benefit from gaining weight. If you are underweight, you are also at higher risk of problems in pregnancy, labour and delivery.
For men: It is accepted that obesity (BMI>30) may have an adverse effect on sperm production. Men who have a suboptimal sperm test where it is believed that weight loss may improve fertility are advised to lose weight before pursuing fertility treatment.
Weight loss injections
The National Institute for Health and Care Excellence (NICE) recommend that all types of weight loss injections be avoided during pregnancy. Further, it is recommended that all individuals of child-bearing potential (who are able to become pregnant) using weight loss injections should take steps to ensure they do not become pregnant while using the injections.
Seek advice around weight loss injections before starting
Recreational drugs
We would advise both men and women not to use recreational drugs. They are harmful to your health, may reduce your fertility and they are harmful to potential children.
Cannabis in particular can affect sperm quality therefore should be avoided. The effect on sperm quality can be reversed.
Anabolic steroids are very harmful to sperm quality. It can take up to 18 months for sperm quality to get back to normal after stopping steroids and in some men, the effect on sperm quality will be permanent. Some protein supplements also contain steroids so such products should be avoided completely.
If you feel you require further support on stopping using recreational drugs please inform a member of staff.
Cervical smears
It is advised that you ensure that your smears are up to date prior to commencing fertility treatment so that any further assessment or treatment can be undertaken before any potential pregnancy.
Genetic problems
When you attend your first appointment please inform us if you aware of any conditions or illnesses that exist in your family. This will allow us to investigate any risks to you or any child that you may have and ensure that you receive appropriate advice and counselling. We may refer you to a genetics specialist who can offer you specialist advice and arrange further investigations.
Medical problems
If you suffer from any significant health problems, we recommend you discuss planning a pregnancy with your GP or specialist.
There are a number of medications that are not safe for use in pregnancy therefore, it provides an opportunity to switch onto safer medications prior to pregnancy and allow your body to adapt to this change.
If you will be the woman carrying the pregnancy, it is important that all health problems are optimised prior to embarking on a pregnancy as it reduces the risk of complications such as miscarriage or ill health later in pregnancy which could result in a premature birth.
If you have any of the following conditions please seek advice before conceiving:
- Diabetes
- Epilepsy
- Cardiac Disease
- Hypertension
- Renal Disease
- Rheumatological disease
- Inflammatory bowel disease
- Haemoglobinopathies
- Mental health illness
Infections
Sexually transmitted diseases caught at any time may create further problems when trying to conceive. If you are worried about this at any time, we encourage you to visit your local genitourinary medicine clinic.
Travel abroad
Travelling abroad may carry health risks for pregnant women or women who plan to get pregnant (e.g. Covid-19, Zika virus and Ebola). We advise any patients (male or female) who have recently travelled or are planning to travel abroad to refer to the Department of Health guidelines about any risks relating to pregnancy. If you are unsure about this, please discuss with the clinic staff.
To minimise the risk of Zika virus transmission, female travellers (symptomatic or asymptomatic) should not try to conceive naturally, donate gametes or proceed with fertility treatment for 2 months. Male travellers (symptomatic or asymptomatic) should not try to conceive naturally, donate gametes or proceed with fertility treatment for 3 months. If a female partner becomes pregnant use of a condom is advised for oral, vaginal and anal sex during and after travel to a Zika area to prevent the developing foetus being exposed to the Zika virus.
To minimise the risk of Ebola transmission, egg donors and female fertility patients should defer from treatment or donation for 6 months after leaving an area affected at the time by an Ebola outbreak. Sperm donors and male fertility patients should defer from treatment or donation for 2 years after leaving an area affected at the time by an Ebola outbreak.
Covid-19 vaccination
People of reproductive age are advised to have the vaccine if they receive an invitation for vaccination. This includes those who are trying to have a baby as well as those who are thinking about having a baby, whether that is in the near future or in a few years’ time.
There is absolutely no evidence that any of the vaccines can affect the fertility of women or men.
Complementary therapies
At the moment, we do not have a good evidence base to recommend any complementary therapies. There are none that are proven to increase your chances of conceiving. We would not recommend the use of any herbal remedies, as we do not know how safe they are. However, if you are using complementary therapies such as massage or acupuncture to relieve stress and you are finding this helpful there is no reason why you should not continue doing so.
