Once you have made an appointment to see one of our specialists, you will be given access to our patient portal and smart phone app. This will make it easier to complete your medical history and results of any tests you have had done prior to seeing the doctor. Our app also gives you access to further information and resources provided by IVI, and allows you to keep up to date on progress of your treatment.
Please bring valid photographic ID, i.e. in-date passport or UK full driving licence and your NHS number to the appointment; plus, any further test results you may have already received.
At your first appointment, the specialist will review the information you have provided and discuss the results of any previous tests or treatment you have undergone. They will then recommend a way forward which may involve further tests and treatment options.
During this appointment, the specialist may suggest that they carry out a vaginal ultrasound scan to assess your uterus and ovarian function. This is a simple procedure during which most people experience nothing more than slight discomfort.
We may also suggest that a semen analysis is performed while you are in the clinic to assess the viability of the sperm. For the best results, it is necessary for the sample to be produced following a minimum of two days’ sexual abstinence. The maximum abstinence period should be five days.
Depending on the tests involved, this appointment will likely take between 45 minutes and an hour.
Questions about Your first visit
What happens next?
You will receive a summary letter shortly after the appointment, detailing what was discussed and the options provided. This will also confirm the next steps. Whichever treatment pathway you choose, you will need to book a Nurse Planning appointment.
Why do I have to attend a Nurse Planning Appointment?
This is the time when you officially consent to undergo fertility treatment and we ensure you fully understand what is involved, the success rates, risks, any potential side effects and the legal implications of treatment. This is the time for you to ask any questions you have regarding treatment and share any concerns you may have.
If you are having treatment as a couple, you both need to attend together.
You can expect to be in the clinic 60-90 minutes.
During the appointment, we will check that the following are in place before you embark on a treatment cycle:
- The results of an ovarian assessment
- Either a semen analysis result, or that donor sperm has already been purchased
- A recent hormone profile for female patients receiving treatment
- Virology screening results for female patients receiving treatment, unless receiving IUI
- Virology screening results for male partners unless using donor sperm
- The results of a smear test for female patients receiving treatment
- The results of a rubella test for female patients receiving treatment
- Photographic ID and passport numbers (or NHS Numbers) for both parties
We will explain the drug stimulation regime that we’ve worked out for your treatment, including how to use them. Each step will be explained, talking through the process of normal fertilisation and IVF/ICSI or IUI (depending on the relevant options).
Once you are both happy you understand the process, we will go through each consent form and sign them. It’s really important that you feel comfortable with what is written on the forms. You can access all the consent forms from your patient portal app.
If you did not have a vaginal ultrasound scan performed at your initial consultation, this will be carried out during this visit.
Long or Short Protocols
There are two types of IVF cycle; long or short protocol. The short protocol or antagonist cycles are often suggested for patients who have Polycystic ovarian syndrome, as this is used to reduce the risk of ovarian hyperstimulation, a recognised side effect of IVF. In short protocol cycles, the drugs to stimulate the ovaries start on day 2 of the period and there is no down regulation phase.
Starting a cycle of IVF
Your treatment will usually start on Day 1 of your period when you will need to call or email the clinic. We will then instruct you to start the treatment plan as explained in your Nurse Planning appointment.
When you contact us to book your treatment cycle, you will be issued with an invoice. This will need to be paid before a prescription and treatment schedule can be issued.
Most patients have long protocol IVF, which starts with suppressing your hormones so we can manage your next ovulation. This is called down-regulation and is achieved by daily injection and usually takes 2-3 weeks. You don’t start taking these drugs until day 21 of your cycle.
During this time, you should have a bleed. We will arrange a scan appointment to check that the drugs are working properly and that your hormones have “switched off”. At this appointment we will teach you how to administer the ovarian stimulation drugs.
Ovarian stimulation during IVF consists of the administration of daily injections which cause the ovaries to develop more eggs. The eggs develop in fluid filled sacs called follicles.
In order to monitor the development and maturity of the eggs you will need to attend for ultrasound scans. Over a period of around 2 weeks of stimulation, you’re likely to have 1-3 scans, and possibly blood tests, to monitor the development of the egg producing follicles. These are short appointments that last around 20mins, and the results are available later the same day. These scans are included in the price of your cycle.
To be capable of fertilizing, an egg needs to be mature. When the follicles are large enough to indicate that the egg inside each of them is mature, we schedule the egg collection 36 hours after administering an injection of the hormone hCG which causes the oocytes to mature in a similar way as in a natural cycle.
Egg collection takes about 30 minutes and you will be given drugs to make you sleepy so that you do not feel any kind of discomfort during the procedure. With the help of a scan probe, a very fine needle is passed through the vaginal wall and into the ovary to collect the eggs. Usually, around 80% of follicles contain an egg. Once the procedure is finished you will need to stay in the clinic at least an hour but you can go home the same day. You’ll need someone to pick you up; you mustn’t drive for the rest of the day, because of the anaesthetic.
If your treatment uses a fresh sperm sample, it will be provided on the same day as the eggs. You provide the sample at the clinic, in one of our andrology (men’s) rooms.
If you already have sperm in storage, or have chosen a sperm donor, the sample will be thawed on the same day that the eggs are collected.
Preparing the eggs and sperm
The sperm sample provided is prepared to ensure that the very best sperm are being used for insemination.
In Vitro Fertilisation Cycle (IVF) – prepared sperm will be added to the eggs in a culture dish.
Intra-Cytoplasmic Sperm Injection Cycle (ICSI) – a single sperm will be selected and injected into each egg, then put into a culture dish.
The culture dishes are placed in the incubator to allow fertilisation to take place.
The day after your egg collection, the eggs are checked to see if they have fertilised. The embryos are graded as they develop, and this monitoring can continue for up to six days after egg collection. Not every embryo will carry on developing, so the decision about when to complete the embryo transfer will depend on the number and quality of your embryos.
The procedure can feel like a smear test. It usually takes around 15 minutes. A tiny drop of culture medium containing one or two embryos is carefully deposited in the uterus using a thin catheter. You will need to have a full bladder for embryo transfer as an abdominal ultrasound scan is carried out during the transfer to ensure the embryo placement within the uterus is optimal.
During the two week wait until you can do a pregnancy test at home, you will need to take extra progesterone to keep the lining of the uterus thick and to give the embryo the best chance of implanting. We appreciate how long and difficult this time can be. About 17 days after egg collection, you will need to do a pregnancy test.
If you decided before treatment to store any further good quality embryos for further cycles, you’ll be consulted again, and your embryos will be frozen at this stage.
If you’re pregnant, we schedule a scan in the clinic at around 6-8 weeks. If the pregnancy is developing correctly we will discharge you to your GP.
If your period arrives before the test is due, or if the test is negative, rest assured you are not alone. A follow-up consultation is provided for all patients whose treatment is unsuccessful. This consultation gives you the opportunity to fully discuss your treatment cycle and options for the future with one of our clinicians. This follow up consultation is free of charge.
From phoning with day 1 of your period until you know the result of the pregnancy test takes approximately 9 weeks if you undertake a long protocol cycle. In that time, you will make about 6 visits to the clinic.
The timescale for a short protocol cycle is approximately 5 weeks and you will visit the clinic about 5 times.