Wessex Fertility - Consultation Booklet

Consultation Booklet

Thank you for choosing Wessex Fertility for your treatment journey

We are delighted you have chosen Wessex Fertility for your investigations or treatment. Wessex Fertility is part of The Fertility Partnership, a group of clinics both in the UK and Europe and as a group we offer all our patients the care, understanding and expertise that help bring dreams to life. This booklet contains important information you need to start your fertility journey with us so please take the time to read it. We are committed to making your fertility journey as smooth as possible so please ask any members of our team to help with questions you may have and we will be happy to help.

Gillian Dawes General Manager

A Guide to Wessex Fertility

A Guide to Wessex Fertility

What documents or tests do I need to complete before the start of my treatment? We will provide and explain to you the authorisations and consent forms that need to be signed and provided to us before you commence your treatment. You will also need to have some screening tests (some need to be repeated even if you have had them before) and have the results available before your treatment. Will my weight affect my fertility treatment choice? Possibly. For the treatments that we offer at Wessex Fertility the optimum BMI (body mass index) for female patients is between 19 and 28 (and advise a maximum of 35 and minimum of 19). Patients falling outside of our maximum and minimum BMI range can in some circumstances be offered treatment after consultation with the doctor but may have to either gain or lose weight before commencing treatment. Women who are not in the ideal BMI do have a lower chance of success including a higher miscarriage rate and a higher incidence of complications in pregnancy whether conceiving via assisted conception or naturally. Will my age affect my fertility treatment choice? Wessex Fertility offer treatment using own eggs to women up to the age of 44 years and do not recommend using your own eggs over this age group. However, we are happy to discuss this on an individual basis. We offer egg donation to women up to the age of 50 years. There is not an upper age limit for men, but it is recognised that there can be some developmental problems for children born to older men and we would discuss these with you at an initial consultation. Patients who are HIV or Hepatitis positive – can we still have treatment? We regret that we cannot treat patients who are HIV or Hepatitis positive. Under HFEA regulations patients who are infectious for these viruses must be treated in specialist units. We can advise where to seek help in these cases. How private are the consultations? The privacy and dignity of all employees, patients and visitors are respected at all times. Patient consultations are always carried out in a private consulting room. For further privacy patients have the opportunity to be covered and/or screened. Please notify the clinic if you wish to make particular privacy arrangements.

Wessex Fertility is a member of a group of fertility centres known as “The Fertility Partnership”, specialised in providing diagnosis and treatment for fertility, gynaecological and women’s health problems. It is a limited company, (Wessex Fertility Limited) that employs dedicated teams of qualified and experienced staff all of whom actively participate in Continuing Professional Development. The clinic is led by GMC registered consultant gynaecologists with expertise and specialist training in fertility and reproductive medicine. We devise and provide personalised treatment plans within the purpose built premises which include private consulting rooms, laboratories, a theatre and a recovery room. Our specialist teams provide experienced medical, nursing, scientific, counselling and administrative support during treatment according to the unique needs of each patient. Our philosophy is to keep patients fully informed of their treatment management options throughout their consultations and attendance at the clinic. All patients are treated on an out-patient basis but have access to all of the clinic’s support services via the telephone at any time during their registration period with the clinic. Emergency on-call cover for those receiving treatment is provided at all times during the year. Details of a next of kin, friend or representative are held on record at Wessex Fertility as a contact point, in the unlikely case of an emergency. What treatment are available? Wessex Fertility offers a full range of treatment from ovulation induction through to complex IVF with embryo testing. The doctor will discuss with the best treatment option with you, including costs and success rates at your initial consultation. We also offer advice on natural conception, diet, lifestyle and weight management in order to improve your chances of conception and your chance of a healthy pregnancy. How will I know how much the treatment is going to cost? All patients will receive a price list before their private consultation. In addition to this a price list is available to view on our website: www.wessexfertility.com. An estimated personal costing plan will be provided to you at your initial consultation after you have discussed your treatment options. When and how do I make the payment? Payment for treatment is required in full before the treatment commences. Invoices are issued to patients and payment can be made with credit or debit cards, cash or via BACS. With regret, we do not accept American Express.

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A Guide to Wessex Fertility

Does Wessex Fertility undertake research activities? Research activities are carried out at Wessex Fertility in conjunction with the University of Southampton. If you give written consent, body fluids and cells that are normally dis - posed of may be provided for research. A comprehensive discussion regarding research and your options is provided prior to consent. Any samples are supplied to the Universi- ty of Southampton which is duly licensed for such research activities. What should I do if I have a complaint? Please raise any complaint with a member of staff immediately so that we can try to resolve the issue as soon as possible. If you are not satisfied with a response in the the early stage, or you feel it is not appropriate to raise the matter with the staff member, please ask for a copy of our Patient Information Sheet – Complaints Procedure or notify our Quality Manager. How do you ensure that a quality service is being offered? Wessex Fertility is licensed to provide treatments under the Human Fertilisation & Em- bryology Act 1990 and registered under the Care Standards Act. As such the clinic is regularly inspected by the Care Quality Commission and the Human Fertilisation & Em- bryology Authority (HFEA) in line with regulatory requirements. Inspection reports are available as public documents via the regulatory body websites. Our staff are all com- mitted to providing the best quality service possible and take part in regular audits with a view to improving practice. We are also working towards ISO 9001 accreditation. Wessex Fertility General Manager - Gillian Dawes Wessex Fertility Quality Manager - Naomi Cloutman Wessex Fertility Nurse Manager - Jo Payne Wessex Fertility Laboratory Manager - Tony Price Wessex Fertility Patient Support Manager - Rosie Bishop All Wessex Fertility staff are contactable via: info@wessexfertility.com or 02380 706000 Wessex Fertility Registered Manager and Nominal Licensee - Laurel Hird, Head Of Quality The Fertility Partnership Human Fertilisation & Embryology Authority (HFEA) , Finsbury Tower, 103 – 105 Bunhill Row, LONDON. EC1Y 8TG. Tel: 020 7291 8200, Email: enquiriesteam@hfea.gov.uk Care Quality Commission (CQC) , Tel: 03000 616161 Web: www.cqc.org.uk Wessex Fertility Person Responsible - Dr Susan Ingamells PhD, FRCOG Consultant in Reproductive Medicine

Wessex Fertility is often asked about how to improve diet and lifestyle whilst undergoing fertility treatment. After many years of treating patients and advising on a healthy lifestyle that encourages fertility, we have developed a few pre-conceptual diet and lifestyle tips, which you may find helpful. These tips are for both men and women. DOES DIET AFFECT FERTILITY? Foods and fertility are linked in both men and women. If you have a balanced diet, you can increase your chances of conceiving and of having a healthy baby. To maximise the benefits, you should aim to improve your diet three months to a year before conception. WHAT IS THE IDEAL BODY WEIGHT FOR BEST FERTILITY? Ideally you should be as close as possible to the recommended weight for your height when trying for a baby (This is measured as BMI; ideal range 19-25). Being overweight or underweight can reduce your chances of conceiving. Both extremes can stop women from ovulating. You may therefore choose to lose or gain some weight before trying to get pregnant. If your BMI is below 18 or above 35, we will be unable to commence treatment for you and will advise you of ways to achieve a normal body weight prior to commencing treatment. If you are overweight, a sensible eating plan should include lower fat and higher fibre foods, but do not forget to exercise. Extreme weight loss from crash dieting can deplete your body’s nutritional stores, which is not a good way to start a pregnancy. If being overweight or underweight is something that is identified during your fertility journey, your consultant will give you further information about weight gain and weight loss strategies. WHAT IS A HEALTHY EATING PLAN? Healthy eating means eating a balanced diet. The Food Standards Agency recommends eating a variety of foods while trying to conceive, including: • Fruit and vegetables - these can be fresh, frozen, tinned, dried or a glass of juice. Aim for at least five portions a day. • Carbohydrate foods such as bread, pasta, rice (preferably wholegrain) and potatoes. • Protein such as lean meat and chicken, fish, eggs and pulses (beans and lentils). • Fish, at least twice a week, including some oily fish, but not more than two portions of oily fish a week. This includes fresh tuna (not canned tuna, which does not count as oily fish), mackerel, sardines and trout. • Dairy foods such as milk, cheese and yoghurt, which contain calcium. • Iron-rich foods, such as red meat, pulses, dried fruit, bread, green vegetables and fortified breakfast cereals, to build up your resources of iron in preparation for pregnancy. Your body absorbs iron better if you have some food or drink containing vitamin C, such as fruit or vegetables, or a glass of fruit juice with any iron-rich meals.

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200 mg of caffeine is roughly equivalent to one of the following:

In general, you should aim to reduce the amount of high-fat, high-sugar foods you eat (such as cakes, pastries, fizzy drinks, some takeaway and fast foods). Make time for breakfast every day, and keep an eye on your portion sizes at mealtimes and any snacks between meals. SHOULD I TAKE A VITAMIN OR FOLIC ACID SUPPLEMENT? Whilst you can meet almost all your nutritional needs through a balanced diet, some experts believe that even the healthiest eaters could do with some extra help. A supplement though is a safeguard, and not a substitute for a balanced diet as above. Over-the-counter supplements sometimes contain large doses of vitamins and minerals that are potentially harmful to a developing baby. It is therefore sensible to use a supplement for pregnant women even before you conceive, there are specific pre-conception vitamins that you can buy over the counter at any chemist. Alternatively choose a supplement that contains a maximum of 100 per cent of the RDA (recommended daily allowance) of all the included vitamins or minerals. Make sure though that the supplement you use does not contain vitamin A or fish liver oil. For men, a vitamin preparation containing Selenium Coenzyme Q and zinc may be beneficial for sperm health and production. Folic acid is recommended to all; this B vitamin has been linked to a lower rate of heart attacks, strokes, cancer, and diabetes. It also reduces a baby’s risk of being born with defects to the spinal cord such as spina bifida (a serious congenital condition). Women who are trying to conceive should take a folic acid supplement of 0.4 milligrams (mg) or 400 micrograms (mcg). Take this from the time you stop using contraception until the 12th week of pregnancy. In addition, it is good to eat folate-rich foods such as dark green leafy vegetables (e.g. spinach or kale), citrus fruits, nuts, whole grains, brown rice, fortified breads and cereals. Some women will be advised to take a higher dose of folic acid at 5mg daily and this will be recommended to you by your consultant or GP if this is required. All adults, including pregnant and breastfeeding women are recommended to take 10 mcg of vitamin D each day. Most fertility pre-conception vitamins contain this. Vitamin D regulates the amount of calcium and phosphate in the body, which are needed to keep bones, teeth and muscles healthy. In addition it is good to eat vitamin D rich foods such as: oily fish, eggs, certain breakfast cereals and milk. DOES CAFFEINE AFFECT FERTILITY? There is no consistent evidence to link caffeinated drinks (tea, coffee and colas) to fertility problems. However, the Food Standard Agency advises pregnant women to limit their intake of caffeine. Some studies show that having more than 200 mg of caffeine per day may be linked to miscarriage and low birth weight. As part of your preparations you could start reducing your intake of such things as chocolate, cocoa, fizzy drinks and coffee that contain caffeine so that you are used to less before you become pregnant.

• • • • •

2 mugs of instant coffee (100mg each) 2 cups of brewed coffee (100mg each)

4 cups of tea (50mg each)

5 cans of cola (up to 40mg each)

4 (50g) bars of plain chocolate (up to 50mg each)

IS THERE ANYTHING ELSE I / WE SHOULD AVOID? The Food Standards Agency recommends that women who are trying to conceive should also avoid the following: • Too much vitamin A. This means you should avoid eating liver and liver products such as pate and avoid taking supplements containing vitamin A or fish liver oil. You need some vitamin A, but if you have too much during pregnancy, this could harm your baby. • Fish containing mercury. E.g. shark, swordfish and marlin. It is also suggested not to eat any more than two tuna steaks a week (weighing about 140g cooked or 170g raw) or four mediumsize cans of tuna a week (with a drained weight of about 140g per can). High levels of mercury can harm an unborn baby’s developing nervous system. • Smoking and smoky places. Cigarette smoke contains harmful substances to eggs, sperm and developing embryos. • Overheating testicles. This can affect sperm production and quality. Wearing tight lycra for regular prolonged exercise (eg. endurance cycling, marathon running) and having regular saunas, hot baths (eg. hot tubs) are potential causes, and should be re- duced whilst trying to conceive. • Excessive Exercise. High impact, daily intense exercise should be avoided, whilst trying to conceive and during treatment. Some body fat is required for fertility, to “al- low” the body to become pregnant. Extreme exercise during treatment can reduce the chances of implantation of the embryo, if the core body temperature is increased. Moderate and consistent exercise is however encouraged as this improves stamina, and reduces stress and tension. We advise 30 minutes 3 times per week as a safe guide. • Excessive stress. This impacts the way your body functions. Prolonged periods of stress affect pre-conceptual health and should try to be avoided to help conception and improve fertility. Try to identify what situations you find most stressful and then avoid these or, if this is not possible, take time to relax and de-stress at every opportunity. • A hectic, busy life with little time for relaxation, attention to diet or socialising. This often produces problems with sleeping and a reliance on alcohol to relax. A less busy schedule generally promotes more happiness and a greater sense of well-being leading to improved pre-conceptual health.

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Nutritional Therapist

Wessex Fertility work with a Nutritional Therapist to help our patients get the correct nutritional advice both before and during treatment. Rebecca Prendergast is qualified nutritional therapist who sees clients for one-to-one sessions to create a bespoke plan to suit their particular needs. The introduction below is from her website.

• Medication. It is important that your GP is aware you are trying to conceive if you are taking regular medication, as some should be avoided in pregnancy as they can cause harm to the developing fetus. Common medications needing to be reviewed are those controlling: high blood pressure, epilepsy, diabetes, depression, fungal infection and thyroid disease. DOES DRINKING ALCOHOL AFFECT FERTILITY? Yes, excessive drinking affects fertility in men and women. It is sensible to cut out or only occasionally drink alcohol when trying for a baby. Current Department of Health advice suggests there is no safe limit. Any effect on fertility and the developing fetus increases the more alcohol is drank, so we advise stopping completely, or limiting drinking to no more than one or two units of alcohol per week. A unit is half a pint of standard strength beer, lager or cider, or a pub measure of spirit. A glass of wine is about two units and alcopops are about 1.5 units. Heavy or binge drinking can harm the developing fetus. You should stop/reduce drinking as soon as you stop contraception. WHAT SHOULD I DO IF I FIND OUT I AM PREGNANT? Maintain the lifestyle changes you have already made and continue to protect your growing baby by doing the following: • Folic Acid – continue to take this until the end of week 12. This reduces the risk of your baby having a neural tube defect. After 12 weeks, the neural tube has closed so the supplements are no longer required but not harmful if you choose to continue to take them as part of a pre-conception vitamin. • Alcohol – This should be avoided in pregnancy • Diet – as in the pre-conceptual advice above but also: o Avoid unpasteurised milk, soft or blue cheeses and pâté (Including vegetable pâté). These can be a source of Listeria and should be avoided. Listeria is an infection which can cross the placenta and cause a serious infection in your baby. o Avoid raw eggs and undercooked meat (especially poultry) which may cause Salmonella infection. o Pregnancy hormones tend to slow down bowel activity and may lead to constipation. Ensure that you have plenty of fresh fruit and vegetables and adequate fibre – you should also try to drink two litres of water per day. • Exercise - It is fine to continue with your regular exercise, but in early pregnancy avoid very strenuous exercise that will raise your core temperature. • Medicines - Any prescription medicines should be discussed with your doctor. Avoid over the counter medicines as far as possible. Always check with the pharmacist if you do need to take something. Paracetamol based products are fine, but you should avoid products containing Ibuprofen. • Complementary therapies- There is little data on the safety of complementary therapies, hence they are best avoided.

Hello! My name is Rebecca, and I am a certified Advanced Fertility Nutritional Advisor, Nutritional Therapist and Master Herbalist.

I decided to retrain in these areas having faced my own fertility challenges and feeling a strong calling to support women in the same situation, teaching them how to optimise their own personal fertility. It can be so easy to compare ourselves to others, particularly in the emotive area of fertility - however no two women, no two couples and no two fertility journeys are the same. I work with clients in person and online all over the world and my absolute passion is supporting them, and their partners if applicable, on their individual journey. I believe every single woman has the right to be able to take control of her fertility at what can be a time full of excitement, joy, anxiety, uncertainty, frustration and fear, depending on your experiences and associations. My clients are a wide range of women (and partners), from those who haven’t yet actively begun trying, to single women on their 4th IVF cycle, to couples in their 40s, to those in the first stage of pregnancy - and every scenario in between.

I am fully insured, accredited with the globally recognised IICT and I am wholly committed to ongoing certified personal development.

If you would like more information on Rebecca’s services please go to her website: www.neomafertility.com.

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Risks of Fertility Treatment

Risks of Fertility Treatment

WHAT RISKS ARE ASSOCIATED WITH THE EGG RECOVERY? a) Post-operative Pain

Fertility treatments, as with all medical treatments involving drugs and surgery, can carry some risks to you. These risks will be discussed with you by your consultant and you should consider them before you start your treatment. WHAT RISKS ARE ASSOCIATED WITH THE DRUG TREATMENT? A. Down Regulation/Suppression Medication e.g. Buserelin, Prostap, Synarel These medicines can cause mild side effects including hot flushes, mood changes, headaches and restlessness. The side effects are usually worse around the suppression blood test and improve once the ovaries respond to the stimulation medication. Very rarely a rash can be seen with this medication and you must contact the clinic if this occurs so the medication can be changed. These tablets can cause mild side effects with mood changes and hot flushes being the most common. NOTE: If any visual disturbance is experienced the medication should be stopped immediately and the clinic informed. b) Gonadotrophin injections It is rare to experience side effects from the ovarian stimulation medication but occasionally a mild skin reaction around the injection site is seen. More commonly abdominal discomfort will be felt as the ovaries are stretched by the developing follicles. c) Antagonist injections These rarely cause side effects. The most common problem is a skin reaction around the injection site that can last for a couple of hours. d) Luteal support medication e.g. utrogestan, cyclogest pessaries, progesterone injections All of these medications contain progesterone which can make you feel emotional and can cause sore swollen breasts as the main side effects. i. Pessaries can sometimes cause a local soreness around the vulva and vagina. It may help to use a small amount of a barrier cream such as conotrane on the vulva if you do experience soreness. Alternatively the pessaries can be used rectally but as the absorption is reduced you will need to use one extra pessary a day at night time. ii. The injections are intramuscular and can cause pain at the injection site. e) Sedation medication given in theatre e.g. midazolam and pethidine These medications can cause nausea and vomiting. Anti-sickness drugs will be given in theatre but sometimes nausea can still occur. Being well hydrated at the time of the egg recovery can reduce this so you will be advised to have a large drink of water two hours before the procedure. You may feel tired and sleepy for a couple of days after egg recovery as a result of the medication. It is important you do not drive or operate machinery at this time. B. Stimulation Medication a) Anti-oestrogen tablets e.g. Clomid and letrozole

After egg recovery the ovaries can swell and stretch the ovarian capsule. This causes pain which can be severe on the night after egg collection. It is not harmful but can be distressing. You will be given some stronger pain killers to use for the first 24 hours to help with this pain. Sitting in a reclined position with pillows under your knees can take pressure off the ovaries and ease the discomfort. b) Vaginal Bleeding As a fine needle is passed through the back of the vaginal wall into the ovary to collect an egg occasionally there will be bleeding from the puncture site into the vagina. This usually settles within a few hours but if it is heavy and does not settle, you need to contact Wessex Fertility for advice. Extremely rarely there may be internal bleeding needing assessment in hospital. c) Bowel Disturbance It is common to experience some bowel disturbance after egg collection. Some women will have diarrhoea while others may be constipated. Bowel movements are often delayed for two to three days after the egg collection and this can make you feel bloated and uncomfortable. Usually the bowels will resume their normal activity without the need for medication but occasionally a mild medicine such as lactulose will be needed. Bowel spasm can be experienced which may be extremely uncomfortable and we would advise using painkillers such as paracetamol until the spasm passes. Extremely rarely a bowel perforation may occur especially if there has been previous extensive surgery in the pelvic region. If this was suspected hospital admission would be arranged. WHAT IS OVARIAN HYPERSTIMULATION SYNDROME (OHSS)? Ovarian hyperstimulation syndrome is a dangerous over-reaction to fertility drugs used to stimulate egg production. It is rarely seen with ovulation induction medication or in intrauterine insemination (IUI) cycles using very low gonadotrophin doses. In IVF treatment 5% of all cycles have this as a complication. It is more likely to occur in women with a high ovarian reserve who are young or have polycystic ovaries. OHSS can cause symptoms of abdominal swelling and pain with shortness of breath, feeling faint and reduced urine output. It usually occurs several days after egg collection when the ovarian cysts fill with fluid and the fluid collects in the abdomen. In severe cases the fluid also collects around the lungs. Hospital admission may then be needed to ensure adequate hydration and treat the symptoms of pain and nausea. If you have concerns that you may have ovarian hyper-stimulation, please contact Wessex Fertility. IS THERE A RISK OF AN ECTOPIC PREGNANCY? An ectopic pregnancy happens when an embryo implants outside the uterus most commonly in the fallopian tube. The chances of having an ectopic pregnancy are higher

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Risks of Coronavirus and Fertility Treatment

Risks of Fertility Treatment

with IVF especially if there is already a problem with the fallopian tubes. The incidence of ectopic pregnancy with IVF is approximately 1-3%. The symptoms are usually pain on one side of your abdomen with vaginal bleeding at around 6-8 weeks of pregnancy. Ectopic pregnancies can rupture and cause internal bleeding requiring urgent medical attention in hospital. Very rarely an ectopic can also occur in conjunction with a uterine pregnancy where more than one embryo has been transferred. If you are thought to be at a high risk of an ectopic pregnancy an early ‘location’ scan will be performed at 6 weeks to check the location of your pregnancy(ies). If you have any of ectopic symptoms described above, please contact Wessex Fertility. WHAT ARE THE RISKS ASSOCIATED WITH A MULTIPLE PREGNANCY? Having a multiple birth is the greatest health risk associated with fertility treatment. The HFEA has imposed restrictions on the number of embryos that can be transferred in IVF treatments to reduce the number of multiple births. We also restrict ongoing treatment if more than two follicles have developed in an ovulation induction or intrauterine insemination (IUI) cycle. Multiple births carry health risks to the health of the mother and the unborn baby. The babies are more likely to be premature and to have a below normal birth weight. The risk of cerebral palsy is also higher in twins than in singletons. Please read Wessex Fertility’s Patient Information Sheet – Embryo Transfer Policy for further information on current statistics and our advice and policy. A useful website for you to visit prior to deciding on the number of embryos to transfer is www.oneatatime.com POSSIBLE BIRTH DEFECTS FOR BABIES BORN FOLLOWING ASSISTED CONCEPTION Some research has suggested that fertility treatment may be associated with an increased chance of birth defects. It’s not yet clear whether the birth defects are a result of the fertility treatment itself or fertility problems in the parents. The main thing to know is that birth defects in the general population are low: two per cent of children in Europe are born with birth defects. If fertility treatment is associated with an increased chance of birth defects, the risk is still very low. Research in this area is ongoing and we will continue to review and update our information as more evidence becomes available. Damage to other organs in the pelvis during fertility treatments The ovaries lie close to blood vessels, bowel, the uterus and bladder. It is extremely rare for there to be injury to any of these at egg collection or drainage of ovarian cysts (estimated < 1/1000). The needle used for collecting the eggs and draining cysts on the ovary, passes through the vaginal wall into the pelvis and ovary. There is a very small risk of infection in the ovary because of this (estimated < 1/1000). The risks are a little higher for women who have endometriosis or previous tubal infection and for this reason we advise giving antibiotics at the time of egg collection.

In view of the Coronavirus pandemic The Fertility Partnership (TFP) want to give you information to help you decide when is the right time to start fertility treatment. All treatment cycles involve travelling to and from the clinic for tests, monitoring and procedures. The Government have published guidelines on hygiene, social distancing and travel (for instance use of public transport) to help reduce the risk of infection when outside your home. We advise all patients to read the up-to-date Government information in order to minimise their own risk. During this period, all consultations will be done via Skype or telephone in order to reduce patient travel and footfall in the clinic. All TFP clinics have policies in place to minimise the risks of patients and staff passing on or catching the virus from others. These measures include questionnaire and temperature screening of everyone (patients and staff) entering the building, social distancing measures, appointment and procedure times spacing, extra hygiene measures and appropriate PPE (personal protective equipment) use. We will also be ensuring that appropriate fertility treatments are used to minimise the risk of complications such as OHSS (ovarian hyper-stimulation syndrome) and multiple pregnancy. We will be tailoring your treatment plan for you based on underlying risk factors, for example suggesting the use of a short antagonist IVF protocol to women at high risk of OHSS. This is because we want to reduce the chance of you developing a complication of fertility treatment which, if you also caught Coronavirus, could worsen your illness. We also want to minimise the chance that you would need to be admitted to a hospital because of a fertility treatment or pregnancy complication at this time, when the NHS is under strain. This may involve delaying fertility treatment if you have severe underlying risk factors. The Royal College of Obstetricians and Gynaecologists (RCOG) have published up-to-date guidance on the risks of Covid-19 to pregnant women and their baby. In summary they state that: • Generally, pregnant women do not appear to be more likely to be seriously unwell than other healthy adults if they develop coronavirus • The large majority of pregnant women will experience only mild or moderate cold/flu like symptoms • As this is a very new virus, we are just beginning to learn about it. There is no evidence to suggest an increased risk of miscarriage • Hospital Early Pregnancy Assessment Units (EPAU) may have different policies at this time when looking after patients • Transmission of the virus from a woman to her baby during pregnancy or birth appears possible. However, this does not seem to cause a problem with the baby’s health after birth • It does not seem that the virus causes problems with a baby’s development during pregnancy • Government guidance on hygiene and social distancing should be followed to reduce the risk of catching coronavirus . If you have any questions regarding your situation then please contact us via the Patient Portal, email or telephone and we will be happy to discuss further.

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Fertility Counselling

Fertility Counselling

How can Counselling help with fertility treatment?

Catherine Hughes - Wessex Fertility, The Freya Centre, Southampton 02380775288

• Fertility treatment can be a stressful, emotionally challenging experience for those undertaking it and for those supporting. Some patients have described it as an ‘emotional rollercoaster’. • Counselling offers you a confidential space to talk about your thoughts and feeling with an independent, trained, non-judgemental counsellor. It is a place where you can work through difficult situations and talk about the fears, anxieties, or distress that you may be experiencing during your fertility journey.

Jackie Riley - Hackwood Surgery, Basingstoke, or Broadwindsor, Dorset. 01308 868949, 07732556187

Vicky Parkin - East Sussex info@vickyparkin.co.uk (email preferred contact) or 07887 527955

Zoe Foster - Cowplain, Near Waterlooville info@thefosterpractice.co.uk or 07764667249

• Talking about your situation and how you feel can increase your ability to cope, make choices and change aspects of your situation.

Booking a Session Please discuss counselling with any of our medical team or to book a counselling appointment, please use contact details above. Sessions are 50 minutes (60 minutes at the Freya Centre). If you are unable to attend an appointment for any reason we would appreciate at least 24 hour’s notice of a cancellation or you may be charged for the missed session. CONFIDENTIALITY The counsellors are regulated by BACP/UKCP and the BICA guidelines. The information you disclose is confidential and will not be fed back to any other member of Wessex Fertility unless it raises concerns about risk of harm to yourself, others or to the welfare of a future child. If there is concern about risk, the counsellor will always discuss this with you first but will speak to the medical team. The counsellors are independently supervised as part of the requirements of BACP/ UKCP and BICA. Therefore, they may share some information anonymously with their supervisors for the benefit of their patients and for their own CPD. We recognize that going through fertility treatment can be emotionally distressing and may have an impact on your relationships with others. The emotions can be conflicting and intense. Support counselling provides an opportunity for you to explore your current situation – how you are feeling, thinking and behaving. It provides the opportunity to look at ways of supporting yourself through difficult periods, to look at options available and to be heard by an independent confidential, professional. There are two types of Counselling available Support counselling

• Undertaking certain treatments such as surrogacy or donating or receiving donated eggs, sperm or embryos raises many issues to consider now and into the future. Counselling for these types of treatments can guide and facilitate discussion, provide information and offer an opportunity to explore how you are feeling. Counselling availability As part of our on-going patient care and in line with the recommendations of the HFE Act 1990 we routinely offer counselling to all patients at any time before, during, or after fertility treatment. Counselling is available to individuals, to couples or to a group dependent upon need. Sometimes counselling may be a requirement as part of the treatment or may be recommended by a member of the medical team.

Counselling is included within the price of IVF and IUI treatment. Where it is not inclusive, a charge is payable in advance. Please refer to the price list.

The Counselling Service You can choose a counsellor from our team of qualified, accredited counsellors. They are guided by their professional codes of practice and values as set out by the British Infertility Counselling Association (BICA) and either by the British Association of Counsellors and Psychotherapists (BACP)or the United Kingdom Council for Psychotherapy (UKCP).

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Fertility Counselling

Obligatory Screening Tests

WHY ARE SCREENING TESTS REQUIRED? Screening tests are a mandatory requirement by the Human Fertility & Embryology Authority (HFEA).

This can help you to adjust to and accommodate both the short and long-term consequences of infertility and treatment. You might find that you need support at different stages of treatment, therefore support counselling can be undertaken before, during and after treatment. How much counselling you have is dependent on your individual needs. Implications Counselling Implications counselling provides an emotionally safe place in which to reflect on and understand the proposed procedure, the variety of issues that may impact on you and the lasting implications for you and those close to you now and in the future. It takes account of, the welfare and needs of the future child.

WHICH SCREENING TESTS ARE REQUIRED? This is a summary table of the standard tests required:

It is an opportunity to anticipate and plan for this conception and family formation.

Counselling is strongly recommended if you are using donated sperm, eggs or embryos through donor assisted conception, here or abroad. This is a different way of creating a family and there is much to consider for yourselves and your intended child now and in the future. Implications counselling is routinely offered before treatment to enable you time to decide how or whether to proceed.

If you are undertaking surrogacy or are using a known donor then it is a clinic requirement that you have counselling prior to treatment.

Please take note that at times the counsellor is part of meetings with other members of the medical team, there may be occasions when the knowledge from your implications counselling may be required to factually inform the situation without releasing confidential information. If there is anytime within the implications counselling you wish for this to not be the case, it is important that you inform the counsellor.

PLEASE NOTE • These tests have to be completed and valid for treatment to commence. • For first IVF or IUI cycles, treatment cannot be undertaken according to HFEA regulatory requirements unless the screening was carried out within 3 months of the start of IVF or intrauterine insemination treatment. • For frozen embryo cycles the male partner’s bloods do not need to be repeated as they are valid from when the embryos were created. • Following the birth of a baby screening will need to be repeated.

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Obligatory Screening Tests

Success Rates IVF Fresh and Frozen Pregnancy Results Jan - Dec 2019 Fresh IVF Cycles

IF I AM A BLOOD DONOR DO I STILL NEED TO HAVE ALL THE TESTS? We can accept a photocopy of your blood donor card for your blood group but all other infection screening will need to be done at the clinic. WHAT HAPPENS IF I HAVE ALREADY HAD SCREENING TESTS TAKEN ELSEWHERE? The screening tests must be current i.e. for infection screening within 3 months for all first IVF or IUI treatments or the last 24 months for further treatments and all tests must include all those tests detailed on the chart above. You may provide us with a copy of the results but the document must clearly state: • Your name and date of birth; • The date the test was carried out; • A list of what was screened and the result. CAN I ASK MY GP TO DO MY SCREENING TESTS? GP surgeries will not undertake the required NAAT testing for Hepatitis B, Hepatitis C and HIV. CAN YOU TREAT SOMEONE BEFORE THE TEST RESULTS ARE KNOWN? We are not able to treat anyone without having the obligatory screening results in place prior to booking a consenting appointment. HOW CAN I ARRANGE THESE TESTS? Screening tests are booked by ringing Wessex Fertility on 023 8070 6000. Appointments are available at Southampton or one of the satellite clinics. It is your responsibility to ensure the results are forwarded to us with the correct information prior to booking your consenting appointment.

Female Age

Positive Pregnancy Test Rate

Clinical Pregnancy Rate

37 years and under 38 years and over

43.4% 33.5%

33.5% 26.4%

Pregnancy Results Jan - Dec 2019 Frozen IVF Cycles

Female Age

Positive Pregnancy Test Rate

Clinical Pregnancy Rate

37 years and under 38 years and over

61%

47.4% 33.7%

48.4%

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Success Rates Live Birth Rates 2017

Success Rates - Multiple Pregnancy Rates 2018 Multiple Pregnancy Rate Jan - Dec 2018 Fresh IVF Cycles

Live Birth Rates Jan - Dec 2017 Fresh IVF Cycles

Female Age

Sum of embryos Transferred

Count of Live Birth events

Percentage Live Birth Rate

Female Age

Number of Pregnancies

Number of fetal heart beats

Percentage Multiple Birth Rate

35 years and under 36 years and over

207 220 427

78

37.7% 14.1% 25.5%

35 years & under 36 years & over

66 50 116

67 55

1.5% 10% 5.2%

31

All ages

109

All ages

122

Live Birth Rates Jan - Dec 2017 Frozen Cycles

Multiple Pregnancy Rates Jan - Dec 2018 Frozen Cycles

Female Age

Sum of embryos Transferred

Count of Live Birth events

Percentage Live Birth Rate

Female Age

Number of Pregnancies

Number of fetal heart beats

Percentage Multiple Birth Rate

35 years and under 36 years and over

326

122 29 151

37.4% 32.3% 32.3%

35 years & under 36 years & over

170

180

5.9% 14.6%

141

48

55

All ages

467

All ages

218

235

7.8%

Live Birth Rates Jan - Dec 2017 IUI Partner

Multiple Pregnancy Rates Jan - Dec 2018 IUI Partner

Female Age Count of insemination procedures

Count of Live Birth events

Percentage Live Birth Rate

Female Age

Number of Pregnancies

Number of fetal heart beats

Percentage Multiple Birth Rate

35 years & under 36 years & over

11

2 0 2

18.2%

35 years & under 36 years & over

0 0 0

0 0 0

0% 0% 0%

12

0%

All ages

23

8.7%

All ages

Live Birth Rates Jan - Dec 2017 IUI Donor

Multiple Pregnancy Rates Jan - Dec 2018 IUI Donor

Female Age Count of insemination procedures

Count of Live Birth events

Percentage Live Birth Rate

Female Age

Number of Pregnancies

Number of fetal heart beats

Percentage Multiple Birth Rate

35 years & under 36 years & over

35 44 79

7 6

20%

35 years & under 36 years & over

11

11

0% 0% 0%

13.6% 16.5%

1

1

All ages

13

All ages

12

12

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Embryo Transfer Policy

Why do we need an embryo transfer policy? The aim of fertility treatment at Wessex Fertility is a safe pregnancy and the delivery of a single healthy full-term baby. This is the best outcome for everyone. The chance of a multiple pregnancy happening naturally is about 1 in 80 pregnancies. However, with fertility treatment, around 1 in every 4 pregnancies results in a multiple birth. A multiple pregnancy is the single biggest risk for a woman or baby when having fertility treat- ment. We therefore try to reduce this risk by having an embryo transfer policy. What are the associated risks of a multiple pregnancy? For babies - The biggest risk is being born early. 44% of twin pregnancies result in a premature delivery. Premature babies often need neonatal intensive care for many weeks. Some of these babies do not survive and others have long term health prob- lems. Twin pregnancy risks include: • Neonatal death - 7 times higher in a twin pregnancy than a single pregnancy where the rate is 3 per 1000 births; • Cerebral palsy - 5 times higher in a twin pregnancy than a single pregnancy where the rate is 2.3 per 1000 births; • Still birth - 3 times higher in twin pregnancy than in a single pregnancy where the rate is 5 per 1000 births; • Other disabilities - twice as high in a twin pregnancy than a single pregnancy. For mothers - A twin pregnancy places a much greater strain on women. They have higher rates of complication than with a single pregnancy. Up to a third of multiple pregnancies will have a miscarriage. Hospital admissions during a multiple pregnancy are more likely than with a single pregnancy. A multiple pregnancy can also cause long term serious health complications for women. For families - In the early years the demands of looking after two or more babies are high. They are likely to be more prone to illness, need more check-ups or visits to the hospital/GP and may have learning difficulties and long-term health problems. The ad - ditional strain of the pregnancy and the delivery of more than one baby can affect the following: • Relationship problems – irritability, tiredness and time pressures when caring for more than one baby can result in tensions and anxieties. • Financial problems - costs can be considerable for more than one baby. How can these risks be reduced? The chances of a successful embryo implantation and pregnancy are linked to many fac- tors; not just to the number of embryos transferred. We assess each patient individually and offer you our best advice on how to achieve a good outcome.

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Embryo Transfer Policy

Couple Carrier Screening

What is our embryo transfer policy? It is to assess each patient against the following decision flowchart and transfer the number of embryos indicated at the end. The final number of embryos to transfer is, of course also dependent upon the quantity and quality of the embryos that are available. It is usual to freeze any surplus embryos, for possible future use, provided they are likely to survive the freeze and thaw process. When is a decision made about how many embryos to transfer? We will be able to decide on the optimal number of embryos to be transferred when the embryo quality is known. We discuss the number of embryos to be transferred with you at initial consultation and prior to embryo transfer. If you have any concerns about the number of embryos to be transferred we are happy to discuss this with you. Summary Flowchart – Wessex Fertility Embryo Transfer Policy

WHO IS THIS LEAFLET FOR? This information leaflet contains information for our patients who will be offered the option of carrier screening. This information leaflet will explain what this means for you as a gamete recipient or as a couple pursuing fertility treatment with your own gametes. WHAT IS CARRIER SCREENING? All our genes come in pairs and it is quite common to be a carrier of a condition, i.e. have one faulty copy of a gene. Carriers also have a working copy of the gene, to compensate for the faulty one. We often do not know if we are carriers, because this causes us no health problems and we may not have any family history of the condition(s) in question. Some genetic conditions arise as the result of a child inheriting two faulty copies of a gene, one from each parent. If a child inherits two faulty copies, they have the condition. This is called autosomal recessive inheritance. Previously, we did not perform routine carrier testing of such conditions prior to pregnancy, because each condition is individually rare. Recent advances in genetic technology means it is now possible to test for many different carrier states in just one test (for the test discussed here we have included 70 conditions). By combining 70 different conditions we find that the overall chance of both people being carriers for the same genetic condition is around 1 in 150. We call this test preconception carrier screening. WHO IS THIS TEST FOR? The test is performed before the start of the treatment. This can be either treat- ment for two people using their own gametes, or couples and individuals pursu- ing treatment using donor gametes. WHAT IS THE CHANCE OF BEING A CARRIER COUPLE AND WHAT DOES THIS MEAN? The chance of both people being a carrier for one of the tested conditions is approximately 1 in 150. If a family member has already been diagnosed with such a condition, or if both people whose gametes are used to conceive are related biologically (i.e. cousins), the chances of being carriers could be higher. The tests check the two people whose gametes are used to conceive the child. The result of the combination of the two is the only result which has health impli- cations for the future child. The test will result in one of two outcomes: • both gamete providers are a carrier of the same genetic condition and the chances of any future child affected by this condition are greatly increased. • both gamete providers are not a carrier of the same genetic condition included in the test and there are no health implications for a future child.

Further independent information on this subject is available on www.oneatatime.org.uk.

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