Preparing For IVF: Screening & Tests My Baba 2 January, 2019 Fertility, IVF diary, Pregnancy Struggling to conceive naturally can be incredibly stressful for couples or individuals looking to start a family. However, it is important for everyone in this position to understand that, should they encounter a fertility problem, today there are more options available than ever before to help turn the dream of becoming a parent into a reality. Different assisted reproduction treatments cater for different needs, with some of the most common including: natural or mild IVF, egg donation, ICSI and IUI. However, for anyone planning to explore assisted reproduction it is important to undergo significant testing beforehand. This will help to identify if there is a problem and, if treatment is recommended, ensure that the resulting plan is specifically tailored to individual needs – maximising the chances of a healthy pregnancy and a successful live birth. Whether you are currently considering undergoing fertility treatment, or would just like more information about what tests should be considered to assess IVF suitability – here, Dr James Nicopoullos, Consultant Gynaecologist at the Lister Fertility Clinic, part of HCA UK, offers his expert advice: Go For A Fertility MOT A fertility MOT or fertility assessment is a worthwhile investment for those individuals and couples who are looking to start a family or who are keen to assess their fertility status. These tests are designed to give people insight into whether conception and pregnancy will be straight forward and help them decide how quickly they should consider their family. On occasion it may identify a factor that suggests that assisted reproduction may well be the most likely route to a successful live-birth and potentially save years of failure trying naturally. There is the option to have individual male or female tests, or a couple’s assessment. Medical History: An overview of medical, surgical and family history to assess any factors that may impact fertility’ Lifestyle Overview: An assessment of lifestyle factors, with advice given on any modifications that may be of benefit when looking to conceive Body Mass Index: An assessment of BMI and advice on how this may, if at all, impact on fertility. AMH Blood Test: A test which is used as a vital marker of ovarian reserve (female only) Antral Follicle count on Scan: Another test which is used as a vital marker of ovarian reserve (female only) Transvaginal Scan: As well as assessing the female follicle count, a scan will identify other factors such as endometriosis or fibroids that may impact on fertility (female only) Thyroid function: Thyroid disease can impact on cycle regularity, fertility and affect miscarriage risk so the clinic assesses this with a simple blood test (female only) Semen Analysis: For males, assessment of a semen sample is carried out (after 3-5 days of abstinence) within half an hour of production to look at sperm number, movement and structure (male only). For most people, the assessment will offer reassurance. However, on occasion, the results may lead to a recommendation for further investigation, such as tests for tubal patency or a more formal male assessment if any sperm abnormalities are identified. Following these tests if further issues or areas of concern are identified, then recommendations for assisted reproductive treatments such as IVF are then discussed. Ovarian Reserve Testing An Ovarian Reserve Assessment tests the quantity of the follicles left in the ovary at any given time, using an AMH blood test and Transvaginal Scan. All healthy females have a finite number of eggs which irreversibly decline with age. Ovarian Reserve testing is an accurate way to identify egg quantity, which along with age (as a marker of egg quality), can impact significantly on the chances of falling pregnant. In many cases it’s unlikely that there will be anything to worry about, but through such testing potential issues can be identified as early as possible to allow plans to be put into place to help optimise fertility hopes for the future. Investigative Treatments: Tubal Assessments Approximately 15% of couples suffer from tubal subfertility. This is likely to be significantly higher in those with secondary subfertility, which refers to people who are struggling to fall pregnant following previous pregnancies. As a result, an assessment of the fallopian tubes should form part of a first-line fertility investigation, particularly if any risk factors in the medical history. Tubal Assessments can also be valuable for those who suffer from recurrent cycle failure, where a “hydrosalpinx” is suspected. A hydrosalpinx is a build-up of fluid within a blocked fallopian tube that may flow back into the uterus. This can negatively impact the chances of an embryo implanting and increase the risk of a miscarriage. Therefore, it is crucial that a potential hydrosalpinx is investigated fully. If it is confirmed that a patient has a blocked fallopian tube, it will be recommended that this is surgically removed or occluded with a surgical clip to stop it interfering with the uterus. It is worth noting that some studies have suggested there may be a short-term increase in the chance of a natural pregnancy, following a procedure such as a hysterosalpingogram or laparoscopy. Laparoscopy The most effective investigation for assessing tubal patency is a laparoscopy with a dye test. During a laparoscopy, a small telescope is inserted through a tiny 1cm incision inside the navel, and a dye is injected through the cervix. At this point the fallopian tubes are examined to see if they fill with the dye, and to see if they are open to allow the dye to pass through into the pelvis. A laparoscopy is a day case surgical procedure which is performed under general anaesthetic. As this is an invasive test requiring anaesthetic, this tends to only be recommended when other gynaecological symptoms are present such as endometriosis, fibroids, or pelvic inflammatory disease (PID) that also require assessment.” Hysterosalpingogram (HSG) X-RAY A HSG is a simpler and less invasive, X-ray based fertility test which is performed as an outpatient procedure. Iodine-based contrast dye is gently injected through the cervix into the uterus whilst at the same time, x-ray images are viewed on a monitor. If the fallopian tubes are open, the contrast dye will fill the fallopian tubes and then spill from the ends. However, if this does not happen then it indicates there is a blockage which would prevent sperm from reaching the egg, thus posing difficulties in relation to egg fertilisation. Hycosy Ultrasouns Scan Another way to test tubal patency is through a Hysterosalpingo-contrast-sonography (HyCoSy). This is an outpatient ultrasound procedure which is used to investigate the condition of the fallopian tubes and detect abnormalities of the uterus and endometrium (the membrane that lines the inside of the womb). The main reason a woman would have a HyCoSy is as a potential one stop investigation that can assess the pelvis (as in a transvaginal scan) as well as assess the tubes. Blocked fallopian tubes are a common cause of infertility however, this cannot be detected with a regular ultrasound. Therefore, in HyCoSy, a contrast agent (dye) is used to provide a better view of the fallopian tubes on the ultrasound scan. A HyCoSy scan usually takes around half an hour, with the procedure being similar to that of a smear test. A vaginal speculum is gently inserted into the vagina to visualise the cervix. Following this, a catheter is then passed into the uterus through the cervix, and a small amount of saline is injected into the womb. The saline then distends the endometrial cavity (which resembles a triangular shape within the womb). This allows an assessment of the contour and shape of the cavity, identifying any problems such as endometrial polyps, fibroids, or congenital uterine abnormalities which may hinder fertility or conception. Following this, the contrast agent is then passed into the uterus and the fallopian tubes to assess the tubes. If the tubes are open, the fluid will be seen passing through the tubes on the ultrasound screen. However, if the fluid does not pass through, this will suggest that there is a blockage which may impair fertility or make conception difficult. About HCA Healthcare UK HCA Healthcare UK is the country’s largest provider of privately funded healthcare, with 800,000 patient interactions every year. From complex and urgent care, to primary care, outpatient and day-case treatment, we provide expert medical care across our network of hospitals, outpatient facilities and NHS partnerships. HCA Healthcare UK includes London Bridge Hospital, The Portland Hospital, The Harley Street Clinic, The Lister Hospital, The Princess Grace Hospital, The Wellington Hospital, Roodlane Medical Ltd, and Blossoms Healthcare. HCA UK also partner with leading NHS Trusts to provide care at The Christie Private Care, HCA UK at University College Hospital and Private Care at Guy’s About The Lister Fertility Clinic: The Lister Fertility Clinic, part of HCA Healthcare UK, was established in 1988 and is a leading national centre for fertility treatment with over 17,600 babies born. It provides world class fertility services for a range of patients, including patients with a ‘low ovarian reserve’, men experiencing fertility problems, same sex couples and single women. The Lister Fertility Clinic is located at Chelsea Bridge Rd, London SW1W 8RH, with satellite clinics in the surrounding counties, Jersey, and a clinic in The Shard.