When can I be seen?The simple answer is as soon as possible, if this is what you want.
Couples have different preferences as to how they would like to begin their journey. You may wish to come in straight away for a consultation and organise the required tests as you go along, or you may prefer to have some or all of the tests done before the consultation. This is entirely up to you how you wish to pace your care and Mrs Gordon is happy to accommodate your preferences.
It would be helpful and Mrs Gordon would recommend a referral from your GP, but this again is not always necessary.
In many instances, your GP may have already completed some or all of the blood tests including a primary semen analysis. Please obtain a copy of these and bring them in for the Consultation. Alternatively these tests can be undertaken privately here at the Spire Bristol Hospital.
What can I expect at the first consultation?
You will have an hour long initial consultation as it will involve full medical history including life style, examination, discussion of any test results, individual prognosis in your case and management options available to you. It is important that we understand all the factors that may be affecting you so that we can formulate an effective treatment plan.
You will be asked questions on the following topics:
- How long you have been trying to get pregnant
- Menstrual History
- Medical History
- Sexual History
- Family History
- Lifestyle factors, including intake of caffeine, alcohol, smoking and your weight/BMI
- Any medications and allergies
We will then review all the blood tests that you have brought along with you and any semen analysis results, if appropriate. We will also perform a pelvic ultrasound scan within the consultation room to get a clearer understanding of the function of your uterus and ovaries.
We can discuss any questions you may have and plan the next steps forward that are right for you.
What are your charges and costs?
Consultation with Consultant (Uma Gordon) £240 Consultation with Fertility Specialist (Charline Villa) £210 Scan £180
Supporting your treatment elsewhere & abroad:
Scan with free short consult £180
First Steps Fertility Investigations
Includes: 30 min consultation with Mrs Gordon, Semen Analysis, Scan, AMH & Chlamydia blood test
£375 Antral Follicle Count (Egg/Ovarian Reserve Testing) £180 Egg & Tubal Screening : from £103 Detailed fertility consultation £210 Scan £180 Semen Analysis £132
IUI, IVF, ICSI, SSR (in collaboration with BCRM)
Egg Donation Treatment (in collaboration with Instituto Bernabeu Alicante)
please contact the clinic for the latest prices Endometrial Scratch £180 Hycosy £320 Saline infusion scan £320 click here
What is ovarian reserve?
A woman’s ovaries contain her lifetime supply of eggs. When she is younger, there are more eggs available than when she is older. Menopause is reached when her supply of eggs is exhausted. Ovarian reserve is an indirect estimate of the number of egg sacs available at any point in a woman’s reproductive life.
While ovarian reserve can tell us about the numbers of eggs within the ovary, it does not always inform us about their quality and hence their ability to lead to a pregnancy.
How can I determine my ovarian reserve?
In general, female age alone is a good indicator of ovarian reserve. In addition, there are currently three main measures used to estimate the ovarian egg supply, none of these are completely reliable as they all have their limitations.
Originally basal Follicle Stimulating Hormone (FSH) undertaken between day 1 to day 4 of menstrual cycle, day 1 being the start day of the period, was the main measure. However, it can vary from cycle to cycle and therefore cannot be completely relied upon. It is important to take the FSH measurement along with an Estradiol (E2) estimation to confirm the correct timing of the test.
More recently, AMH (Anti-Mullerian Hormone) has been the preferred blood test, as it can be taken any time of the menstrual cycle and the levels rarely vary from cycle to cycle. The limitation, however, is that several assay methods exist and the results can be affected by the way the sample is processed.
The Antral Follicle Count (AFC) is the preferred method used by Mrs Gordon as it allows for direct visualisation of the ovaries and the egg sacs developing within. This test uses transvaginal ultrasound so a full bladder is not necessary and can take up to half an hour to complete. The limitation is the resolution of the scanning machine and the experience of the observer. The additional advantage is that the uterus as well as the rest of the pelvis can be assessed for normality at the same time.
Several studies have examined these tests (FSH, AMH and AFC) alone and in combination with each other and consensus among fertility specialists does vary on what is the best test. Mrs Gordon has found AFC to be reliable in her clinic and additional tests will be requested if necessary.
What if my ovarian reserve is poor?
This is a difficult question to answer and very much depends upon the female age and individual circumstances. For example, a young woman with a reduced ovarian reserve may still conceive with her own eggs, naturally or following assisted reproduction treatments. However, in some patients, donor egg treatment may be recommended as the most efficient way of achieving parenthood.
I have had a semen analysis carried out over a year ago, is it necessary to have another test?
Semen analysis involves a number of tests undertaken on the seminal fluid, including count, percentage sperm motile, percentage sperm looking normal (morphology) and anti-sperm antibodies. In order to be a reliable indicator of fertility, these tests need to be performed within one year or closer to the time of treatment. This is because any one of the parameters measured can change over time and this can affect your chances of natural conception. It can also have a bearing on the most suitable assisted conception treatment recommended for you.
Sometimes an additional semen analysis is required to confirm a finding and it is not unusual to be asked to repeat this test to be sure of the findings.
My husband has had a semen analysis undertaken and they have not identified any sperm
This is a diagnosis of azoospermia and refers to men where no sperm is seen in the ejaculate. We would recommend repeating the semen analysis here to confirm the diagnosis. The reason for this is because some times sperm can be found in the repeat sample especially if the lack of sperm is related to a recent illness.
A confirmed diagnosis of azoospermia can relate to two main reasons; an obstruction in the pathway where sperm production is normal, or there is a problem with the testicular sperm production itself. The management of these conditions varies, as is the success with sperm recovery.
Mrs Gordon has a special interest in treating Male Infertility and has developed a simplified procedure for sperm recovery in the obstructive cases. The chances of sperm recovery in an obstruction situation are close to 100%. With testicular failure cases, there is a reduced chance of sperm recovery at 50%, based on the particular cause.
Do I require a HSG (Hysterosalpingogram)?
A hysterosalpingogram is an x-ray dye test to check for tubal patency and uterine normality. It is indicated in women with no past history of infections or abdominal / pelvic operations. It is a relatively simple test compared to laparoscopy, and is undertaken within the x-ray department at Spire Bristol Hospital. While the test can be informative, it does have its limitations.
It does not show any pelvic adhesions or scarring which can impact on tubal function. For some women, a diagnostic laparoscopy may be the preferred option.
Do I need to have all my blood tests before I can see the consultant?
The simple answer is no. In many instances, there is a lot to discuss at the initial consultation, with your particular history, life style factors and ultrasound scan assessment. The chances of natural conception are discussed in your particular situation and any problems identified. Mrs Gordon will then outline the various tests that are required. Your GP may be happy to help you here or the tests can be undertaken at Spire Bristol Hospital for a charge.
I have had two miscarriages already, should I be seeking treatment for recurrent miscarriage?
Recurrent miscarriage is a diagnosis made after three or more consecutive pregnancy losses prior to 20 weeks of gestation. A variety of tests are undertaken to exclude any causes. It is reassuring to know that the majority of patients proceed to have a healthy baby with little or no intervention. If a cause is identified with the tests, an appropriate management plan can be put forward. It is worth mentioning that a cause is not always identifiable and this is the main difficulty for most couples.
Mrs Gordon, will undertake investigations even after two miscarriages if indicated, or if you have had difficulty in conceiving.
I have been diagnosed with premature menopause. Does this mean that I cannot have children?
This can be a devastating diagnosis for many women especially if they are young with no children. The area of premature menopause (preferred term primary ovarian insufficiency POI) is very complex and poorly understood. There are many causes for early ovarian failure/dysfunction and various tests are undertaken to rule out genetic causes, endocrine problems etc.
Despite a diagnosis of POI, in some patients there is a spontaneous recovery of ovarian function and 5 to 10% of patients can conceive naturally. In the majority, however, it would be necessary to advice the use of donor eggs for conception. The problem relates to egg supply and with unexplained POI, patients are well able to carry a pregnancy to term.