Frequently Asked Questions (FAQs)

1.1 What is IVF / what is ICSI?

In vitro Fertilisation, IVF, literally means ‘fertilisation in glass’ which is where the term Test Tube Baby comes from. ICSI stands for Intracytoplasmic Sperm Injection. It is a modified version of IVF where an individual sperm is injected into an egg to assist with fertilisation when the quality and function of the sperm is not within an optimal range.

1.2 Does IVF / ICSI cause any harm to the baby ?

IVF has been used to help people conceive for over 50 years. ICSI has been producing babies for couples with abnormal sperm for over 35 years.

Louise Brown was the world’s first baby to be conceived via in-vitro fertilization (IVF) and was born in July 1978 at Oldham and District General Hospital in Manchester, England, to parents Lesley and Peter Brown.

The UK was the first country to set up a regulatory authority to oversea IVF processes. The Human Fertilisation and Embryology Authority registers all treatments started and their outcomes. This has generated the most robust database in the world to study the outcomes of babies born from these treatments. We know that there are no obvious serious concerns with treatment. Pregnancies proceed healthily. Children develop normally and there is no increased chance of genetic abnormality or disability.

There are some very rare conditions that might be slightly increased in their occurrence compared with naturally conceived children but they are so rare as to still be under research.

1.3 Is miscarriage more common after IVF / ICSI?

No. Miscarriage is common after natural conception but many pregnancies are lost before a positive test is recognised. About 1 in 3 pregnancies is understood to miscarry. This is the same after IVF conception.

1.4 What is a blastocyst?

A blastocyst is the name given to an embryo that has developed to the stage where the cells have separated into those that will become the baby (inner cell mass) and those that will become the placenta (trophoblast). If an embryo reaches this stage in the laboratory it has a higher chance of becoming a baby, although this is still not guaranteed.

1.5 What does legal parenthood mean?

Legal parenthood provides a lifelong legal parent-child connection which affects a wide range of areas such as your child’s nationality, inheritance and your financial responsibility for your child. It is also important for your child to be clear about who his or her legal parents are.

Legal parenthood will be considered in the following situations:

• a married woman is seeking treatment with her husband
• a woman is seeking treatment with a male partner
• a woman is seeking treatment with a female partner
• a woman has a civil partner or has had a same sex marriage, and is seeking treatment with her partner / spouse
• a married woman or a woman in a civil partnership is seeking treatment with a new partner
• A man donates his sperm, a woman donates her eggs or a couple donate embryos for the treatment of others.
• When an individual does not consider themselves male or female
• When IVF treatment involves using donor sperm, donor eggs, donated embryos or when a surrogacy arrangement is in place.

For more information please log into our Patient Area and access a copy of our Legal Parenthood Information Booklet.

There is also more information on the HFEA website.

1.6 Can I ask for more than one embryo to be transferred?

Our ambition is to achieve a safe pregnancy that leads to a healthy live birth. This is much more likely when embryos are transferred one at a time because twin, triplet or higher order pregnancies are medically ‘complicated’. The human womb is not designed to carry multiple babies at once. Premature delivery is a very significant risk. If this happens very early, e.g. about six months in to the pregnancy, the baby will be underdeveloped and struggle to cope with the outside world. Despite amazing intensive care, many very premature babies will suffer life-long health issues as a result, including cerebral palsy.

It is now quite rare to transfer two embryos together. We will only do this if the chance of both implanting is judged to be low (because their quality is reduced) and the risk to the mother is fair to take. UK law permits the transfer of a maximum of three embryos in special circumstances: i.e. women over 40 (whose chance of pregnancy is reduced by their age-related lower egg quality), when the embryos are of reduced quality or when previous treatments have been unsuccessful.

1.7 I’m due to start treatment but my period hasn’t started

Periods can be a little eratic, particularly in times of stress, try not to worry about this. If your period does not start after 7-10 days from when you expect it to, please give the team a call and we will advise you on next steps which may include giving you a short course of tablets to help bring on a bleed.

1.8 I don’t have periods, can I still have IVF treatment?

Yes, you can still have IVF treatment if you do not have periods. It is important to understand a little more about your individual history before we can give you an appropriate treatment plan. To book an appointment with one of our fertility consultants, please contact us.

2.1 How do I know that Hull & East Riding Fertility is a safe and responsible clinic?

Hull & East Riding Fertility has been providing IVF services locally since 1986. Our founder and clinical scientist, John Robinson, was instrumental in the early years of IVF development and has seen the clinic evolve over nearly 40 years, with more than 3000 babies born.

Our clinic is registered with the Human Fertilisation and Embryology Authority (HFEA) who regulate all providers in the UK. The HFEA regularly inspects all registered providers to ensure that their Code of Practice is followed. We are also CQC registered and hold both ISO9001 (Quality) and ISO15189 (Andrology) accreditations.

2.2 What are the clinic opening hours?

The clinic is fully open 5 days a week, Monday – Friday 08.00-16.00. Additionally, for time-critical procedures (embryo transfers), the clinic is open, with reduced hours and staff, on Saturday mornings.

Of course, we have nurses on call 24/7 to help with urgent clinical matters and our embryology team monitor our incubators and technical equipment 24/7, 365 days a year.

If you need urgent clinical support out of normal clinic hours, please call us on 01482 689040 and press 0 to speak to the nurse on call. Please be aware that this option is only available for urgent clinical matters as for all other queries you will be asked to call back during normal clinic hours.

2.3 Do you offer private treatment?

Yes, we do. About half of the treatment we offer is self-funded. We also partner with Access Fertility, who offer multi cycle and refund packages, as well as the potential to spread the cost of treatment. Please see our fees page for costings.

Unfortunately, fertility treatment does not fall under the remit of private health insurers.

2.4 I am interested in finding out more and coming to see you. What do I do now?

Please contact us directly.

3.1 Do I need to be referred by my GP?

Most patients will be referred by their GP, but this is not essential if you are paying for your treatment. GPs are able to provide basic advice and basic tests which are helpful to the specialist in the clinic. However, patients can self-refer, by contacting us directly and we will conduct specific tests tailored to your circumstances.

3.2 Am I too old for IVF?

The chances of success with IVF treatment are strongly linked to the age of the woman. This is because a woman is born with all of her eggs for life and these reduce in number and quality with time. The reduction in the number of eggs has little impact on success rates until the age of about 38 years and over.

Egg ‘quality’ really refers to the egg DNA (coding required to create a new life), and the mitochondria (engines required to drive the egg to achieve fertilisation). These are affected increasingly as we progress through our thirties and plummet significantly over 40 years. By the age of 43 years more than 90% of human eggs have become abnormal – the DNA is damaged meaning that a healthy pregnancy can not ensue. This is why natural pregnancy, and assisted pregnancy is very rarely successful at this stage of life. Of course it only takes one good egg and there are still a few of those present, so it can, and does happen, but the chances are very significantly reduced. Using IVF to try to increase those chances is flawed because the yield of eggs is substantially reduced for most women by this stage. If 10% of the eggs are predicted to be normal but the IVF cycle only generates a small number, the chances of one from a batch of say, 3, being normal is very low.

For most women, there is still some potential gain from IVF up to the age of 43 years old, especially if you have a good egg reserve (Anti Mullerian Hormone level and Antral Follicle Count), and / or have had a child already.

The NHS only funds IVF for women over 40 if the egg reserve markers indicate that the likely yield of eggs is good (AMH >5pmol/l, AFC >5) and no funding is available once you reach your 43rd birthday. For privately funded patients, following consultation, we generally accept patients up to their 46th birthday if using the ladies own eggs, or up to the ladies 48th birthday if using donor eggs.

3.3 What can we do to increase our chances of successful pregnancy / treatment?

There are many things that only you can do to increase your chances of treatment working.

Weight management – Being a normal weight for your height is key to helping a pregnancy to take off normally. Being underweight is associated with poor growth of the baby and premature delivery.

Being overweight is associated with a reduced chance of pregnancy because excess body weight in the form of fat is metabolically active and adversely affects the development of healthy eggs and sperm. This is especially true of belly fat. This type of fat deep inside the abdomen, around the organs, is different to the fat that builds up under the skin. It produces chemicals (metabolites) that cause ‘oxidative stress’ which damages DNA (the genetic coding in eggs, sperm and the mitochondria that provide the egg with energy to fertilise normally and move towards a pregnancy).

We use BMI to measure body weight and height because this is the measurement adopted by the NHS to create cut-offs for fertility treatment. It is not perfect, but it is a fair guide for most people.

• Underweight BMI <19kg/m2
• Normal weight BMI 19-25 kg/m2
• Overweight BMI 25-30 kg/m2
• Obese BMI >30 kg/m2

You can calculate your BMI here: https://www.nhs.uk/health-assessment-tools/calculate-your-body-mass-index/calculate-bmi-for-adults

• No smoking or vaping for either partner
• No using of illicit drugs (cannabis, cocaine, amphetamines, ketamine, magic mushrooms etc.)
• Minimise alcohol – Keep alcohol intake to less than 6 units a week (not all at the same time). This applies to both partners. You may opt to stop alcohol consumption completely or only indulge gently for special occasions.
• Moderate caffeine intake – You should not consume more than 3 caffeinated drinks per day. This includes tea (English black tea / Yorkshire tea, and some herbal teas like green tea) and coffee and some soft drinks.
• Minimise ultra-processed foods from your diet – It is recommended to avoid ready-meals, take-aways and factory-processed food such as microwave meals, pot noodles, stir-in pasta / curry sauces in jars & sachets, fizzy drinks (full sugar or ‘diet’), cordial, any foods marketed as ‘diet’ products. ‘Diet’ products have often been stripped of fat which removes a lot of flavour and therefore they need to be made to taste better with lots of unhealthy additives. Fat, in moderation, is now known not to be ‘bad’. Sugar is much more dangerous.

Start studying food labels and return to the shelf items with unnatural ingredients such as emulsifiers, stabilisers, preservatives, artificial colours and the myriad of added sugar derivatives (caramel, molasses, glucose, dextrose, fructose, sucrose, lactose, maltose, maltodextrin, agave, honey, barley malt, cane juice / sugar / syrup, corn syrup).

Note that many natural fresh foods naturally contain some of these types of sugars. If the item is completely unprocessed then the sugar it contains is not added and is perfectly safe to consume, in its natural form. Avoid blending fruit into smoothies as this breaks down the fibre and releases the natural sugars too fast. Fruit juice should be consumed in small amounts only, if at all, for the same reason. A whole apple or whole orange are much healthier than squashed ones!

Cooking from scratch as much as possible means that you are in control of the ingredients.

Women with Polycystic Ovary Syndrome are recommended to do further reading on carbohydrate consumption to help with weight management. Some natural foods without added sugars will release their sugars faster than other foods which can upset insulin function in women with PCOS and insulin-resistance. These two tend to exist together. Learning about high glycemic index (GI) foods (releasing sugar rapidly e.g. potatoes, white bread, short grain rice, dates, mangoes) and low GI foods / alternatives can help you make better choices to control your blood sugar and therefore your weight.

Further reading:

• PCOS Diet
• Ultra-processed people
• It starts with the Egg
• The Fertility Book

3.4 How do you test male fertility?

The main test is a semen analysis.

Although you may have already had an andrology semen analysis, for IVF/ICSI treatment will require a more detailed assessment. This assessment is carried out by our Andrology lab and generally requires you to produce a sample on site. We have dedicated and discreet sample rooms for patient use. This more detailed assessment allows us to determine which treatment options are most suitable for you.

The World Health Organisation (WHO) has established the following normal values:

Concentration (count): >16 million sperm per ml of ejaculate
Progressive Motility (proportion of sperm swimming forward): >32%
Normal morphology (normally shaped sperm): >4%

Prior to IVF treatment we also screen males for the below:

• Sexual health screen (urine test for chlamydia and gonorrhoea)
• Virology screen for Hepatitis B, C and HIV

3.5 How do you test female fertility?

The most useful tests of female fertility are:

• Blood Anti Mullerian Hormone (AMH)
• Pelvic ultrasound assessment of antral follicle count and other pelvic pathology
• Fallopian tube test (HyCoSy ‘dye test’)

We require a number of other tests for comprehensive assessment for potential treatment and to optimise general health for pregnancy such as sexual health screen (urine test for chlamydia and gonorrhoea) & virology screening for Hepatitis B, C and HIV.

3.6 What tests should I expect my GP to do before a referral?

We expect basic research to be carried out by your GP; these include the below:

Female partner

• Day 1-3 FSH, LH, Oestradiol
• Day 21 (or menstrual bleed minus 7 days) Progesterone. NB if your cycle is typically 30 days long the correct time to test progesterone is day 23.
• Thyroid function
• Sexual health screen (vaginal swabs for chlamydia and gonorrhea)
• Virology screen for Hepatitis B, C and HIV

Your GP should be able to confirm the following from your health record:

• Cervical smear screening is in date and normal
• Rubella vaccination course has been completed
• They may also check a full blood count and iron (ferritin) to confirm you are not anaemic.
• Women with irregular or absent monthly periods should also have blood tested for Prolactin & Testosterone

Male partner

• Semen analysis
• Sexual health screen (urine test for Chlamydia and gonorrhoea)
• Virology screen for Hepatitis B, C and HIV

4.1 What is the process for fertility treatment?

Below is a brief description of each of the clinical stages of IVF fertility treatment

• Ovarian stimulation
  Daily Follicle Stimulating Hormone injections (given by yourself into the skin of the thigh or stomach) for 9-11 days.
• Ultrasound scan monitoring
  2-3 times during this phase to work out when the eggs are ready to be harvested.
• Ovulation suppression
  Most patients will use a second daily injection (Ganirelix) from day 6 of FSH injection to prevent uncontrolled release of the eggs before we are ready to collect them.
• Ovulation Trigger
  A third drug (hCG (Zivafert) or Buserelin) is given as a single shot at a specific clock time, calculated to be 36h before your eggs will be retrieved. This will be between 20.30 and 23.00 (evening) 2 nights before the collection.
• Egg collection/Ovum Retrieval (OR)
  The day on which we retrieve eggs ready to mix with sperm for the fertilisation process.
• Laboratory journey
  (fertilisation, embryo culture) 2-5 days depending on the number and quality of embryos you have to work with.
• Embryo transfer
  The procedure in which the most appropriate embryo is replaced.
• Luteal support
  Progesterone hormone is used in two different forms: Cyclogest pessaries (vaginal tablets) and Lubion injections. It is taken from egg collection until the pregnancy test (and beyond if the test is positive).
• Pregnancy test
  The clinic will tell you the precise date to perform your test. (please also refer to Question 4.4)
• Pregnancy viability scan
  The primary goal of this scan is to confirm a viable pregnancy, detect the baby’s heartbeat, check the number of fetuses, and accurately date the pregnancy.

4.2 How long does fertility treatment take?

It takes about 8-10 weeks from your treatment getting underway to finding out whether your treatment cycle has been successful.

The treatment is planned around your natural menstrual cycle and begins with the bleed. Sometimes we will give you medication to ‘move / delay’ the bleed in order to manage all the treatments we have running at the same time, safely.

The delicate laboratory work needs to be tightly managed to be safe and secure.

4.3 Does my partner need to come with me to my appointments?

Your partner is welcome to accompany you, but he / she is not required unless they have a physical contribution to make (e.g. Give a sperm sample, sign consent forms in person). For consultation appointments, where you will discuss your history and forward treatment plan, we ask that both partners (if applicable) attend, this is to ensure you are both happy with the plan and are both aware of what investigations may be required before treatment. If you are a single lady and wish to bring a friend or family member with you, this is fine – please let us know in advance.

4.4 How much time off work will I need?

Most patients continue to work through treatment. You need to plan for a minimum of two days off work: the day of your egg collection and the day after. You will have sedative medications that can have a hangover effect for 24 hours, so it is important not to plan any serious decisions around this time. You will also need to be available for scans, monitoring and other appointments throughout your treatment, these appointments range from 20 to 90 minutes. If you need a letter to take to your employer please let us know.

The Fertility Network has a number of helpful resources, including Fertility in the Workplace, for more information, please visit their website page https://fertilitynetworkuk.org/fertility-in-the-workplace/.

4.5 How long do the in-cycle monitoring appointments take?

Your monitoring pelvic scan will take approximately 20–30 minutes. However, we kindly ask that you allow up to one hour for your appointment, as clinics may occasionally run a little behind schedule.

4.6 How long does a nurse-consultation appointment take?

A nurse consultation will take up to 1 hour for new patients and 30 minutes for repeat cycle patients.

4.7 Will I need time off after egg collection / embryo transfer?

You should have the day of your egg collection and the day after off work. You should not sign any legal documents during this time in case you are still under the influence of the hangover effect of the medication we will have used.

You should not need to take any more time off work after your embryo transfer.

4.8 How long will I need to be at the clinic on the day of my egg collection / embryo transfer?

Please make arrangements to be at the clinic for 2.5 hours on the day of your egg collection and 1hour on the day of your transfer.

4.9 I’ve forgotten to take my drugs, what should I do?

Our advice will differ depending on the medication you are taking and the point in your treatment cycle you are at. If you have forgotten to take any of your medication please contact us as soon as possible for individual advice. (Also see above answer).

4.10 Can we have sex during treatment?

You can have sex during treatment if you wish. You may find it uncomfortable towards the end of stimulation and soon after the egg collection due to the swelling and bruising in the ovaries.

We recommend that you abstain (avoid penetrative intercourse) until your cycle is complete (period has arrived / pregnancy scan completed).

4.11 Will I gain weight during treatment?

You will not gain weight that you don’t lose quickly. Any weight gain is likely to be due to water retention but will resolve within days/weeks.

4.12 When will I know if I am pregnant or not?

Your pregnancy test is taken 18 days after embryo transfer (fresh or frozen). A positive test is an excellent start, but you need to wait a few more weeks before a scan will show whether a heartbeat is present and the baby is developing. Once a normal heartbeat has been identified on scan, the chances of a miscarriage are reduced to 5%.

4.13 How soon after my embryo transfer can I do a pregnancy test?

We understand that you will naturally be very keen to know if your treatment has been successful, however it is very important that you do not take a test until the date the clinic has told you to. This is generally 2 weeks after the date of embryo transfer. It is important to wait until this date as testing too early often results in false results; these inaccurate results can be emotionally draining and misleading.

4.14 What happens if treatment doesn’t work for me?

Every unsuccessful treatment cycle includes a follow up consultation to discuss the details of the cycle and to make further potential plans. It is always very disappointing to get a negative pregnancy test result, but we are realistic in helping you to manage your expectations.

It is not uncommon for it to take several embryo transfers before you achieve a pregnancy. Each embryo is genetically unique with its own potential for success. Some patients will generate embryos to freeze from the fresh cycle which allows them to proceed into another transfer cycle relatively quickly.

If the fresh cycle was funded by the NHS, the use of frozen embryos will also be covered, until they are exhausted or a live birth occurs. Some patients will have purchased a package of treatment from Access Fertility with multiple cycles. For patients funding themselves by pay-as-you-go, further treatment with fresh or frozen embryos (if available) will be chargeable.

We recommend a short gap between the pregnancy test and the follow up appointment to allow for the initial, understandable disappointment to wane slightly. It’s important that we plan to start any subsequent cycles at a time when you are ready to do so.

You may already be aware that the clinic offers a support counselling service which can be accessed if you are struggling with your feelings and emotions around the treatment. It depends on how you are funding your treatment if this is included in your treatment fees. For example, if your treatment is funded by the NHS, you have up to 3 sessions included for each funded treatment cycle, equally if you are funding the treatment yourself on a pay-as-you-go basis, the same inclusion applies. However, Access Fertility packages do not include the cost of support counselling and therefore these sessions would have to be paid for at the time of booking.

5.1 Can I use a hot tub/ sauna during or after treatment?

You can use these during the stimulation phase but they are not advised after egg collection due to the small risk of infection. You can have a bath safely after egg collection. You can resume swimming when the outcome of your treatment is known (period or pregnancy test positive) . Note that you will still be using the Cyclogest vaginal pessaries for some more weeks and may prefer not to swim during this time.

Hot tubs & saunas are best avoided once pregnancy is confirmed.

5.2 Can I continue to exercise, go running during treatment?

We recommend avoiding high impact exercise during treatment. This includes running and contact sports. You can undertake low impact exercise such as cycling, swimming, walking as and when you feel well enough and build up to your normal activities as the outcome of your treatment becomes clear. Remember that most women carry on life as normal in the early stages of a naturally conceived pregnancy without causing any harm. The difference with IVF lies in the swelling and bruising of the ovaries.

5.3 Can I continue to see my denist and have dental treatment during IVF treatment?

If you need dental treatment, including anaesthetic, work please proceed.

5.4 Can I go on holiday during/after treatment?

We understand that holidays and family commitments are important. However, once your treatment cycle has started, it’s very important that you’re available for all your planned appointments. These appointments are carefully timed for things like monitoring, medication, egg collection, and embryo transfer.

If you travel during treatment, there’s a risk that we may need to cancel your cycle because of missed appointments or timing issues. If this happens, it could affect the cost of your treatment or any NHS funding, unless it has been discussed and agreed with us in advance.

We strongly recommend that you take any holidays before your treatment begins.

If you need to travel during treatment, for example, for a family emergency, please contact the clinic as soon as possible so we can talk through your options.

Please bare in mind that there are some wider travel restrictions, such as visiting a country where the Zika virus is present will mean your treatment cannot begin until 3 months after your return. Please refer to the WHO website for more information on Zika – https://www.who.int/news-room/fact-sheets/detail/zika-virus.

If you achieve a pregnancy and wish to travel abroad, it’s important that you take advice from your midwife and/or GP before travelling.

5.5 Can I continue to dye my hair/have beauty treatments (acrylic nails/false eyelashes etc.) whilst going through treatment?

The amount of chemicals absorbed by the scalp during dying of hair is minimal. No adverse effects have been shown. Be sensible about the frequency of use during pregnancy if you continue to dye your hair.

There is no reason not to have other beauty treatments during IVF treatment. We use an oxygen monitor during egg collection that pegs onto the tip of one finger. You should have one natural fingernail at this time, please.

6.1 Can I mix injections together to reduce the number of needles?

No, this is not advised.

6.2 Can I get my injections ready (mix them up) the night before?

No, this is not advised

6.3 Do I need to give my injections at the same time every day?

Please develop a routine and give yourself your regular injections within a 2 hour window every day. We suggest choosing the evening because, if a dose adjustment needs to be made after your scan, you can use the new dose that same day.

Note that the trigger injection is given at a specific time that we will advise you, two days before. It is really important that you factor this injection into your evening so that you remember to do it at the time advised. Do not panic about getting it in at the precise minute we have told you. 5–10 minutes either side is fine. It is best to take your time and not make a mistake (lose some / all of the drug onto the floor). You must call the nurse on call phone if you are more than 1h early / late so that we can advise you accordingly.

6.4 If I have any discomfort or pain, what can I take for it?

You can take simple pain killers for common ailments during IVF treatment. Paracetamol 1g (2 tablets) would be the first choice for a headache, for example.

Ibuprofen is an excellent pain killer (400mg or 2 tablets). It is safe to use during IVF if you have not yet had an embryo transfer and you do not have sensitivity to it (people with asthma should not use this family of painkillers, NSAIDs, which include aspirin, naproxen and diclofenac).

6.5 What if I’m prescribed antibiotics whilst going through treatment?

If you need antibiotics during your treatment cycle you should proceed to take the complete course. Please advise the doctor / prescriber that you are undergoing treatment with us.

6.6 Do the drugs need to be kept in the fridge?

Some fertility drugs do need to be kept in the fridge, for example FSH preparations (Ovaleap / Meriofert / Rekovelle) and HCG (Zivafert) need to be refrigerated (between 2 degrees C and 8 degrees C). When we, or our partner pharmacy (Fertility2U), dispense medication we will give you full instructions for storage.

6.7 Should I use my Cyclogest vaginally or rectally? Does it matter?

Most women use Cyclogest vaginally. It is a wax-based pessary. When it reaches body temperature it melts and the wax produces a discharge. The active drug is rapidly absorbed so you should not worry that the medicine is ‘coming out’. You may wish to wear a panty liner to contain the discharge.

Some women choose to use Cyclogest rectally. It works equally well this way and does not produce a discharge.

6.8 Do IVF drugs cause constipation?

Some medications can cause patients to become a little constipated. If you are experiencing these symptoms please increase the fibre in your diet (prune juice can be particularly effective) and drink plenty of water. If these natural remedies don’t make a difference, please contact us for advice.

6.9 What side-effects can fertility medicines cause?

The main ‘side effect’ of fertility medicines is to bring about the development of multiple mature eggs. This is achieved by using injections of the same hormones that the body produces naturally every month, but in higher doses (FSH & LH medicines called Ovaleap, Merofert, Rekovelle). As a result of this process, the ovaries produce more oestrogen hormone than in a natural cycle because each developing egg (follicle) produces its quota of oestrogen. If you have 10 follicles, you have 10 x the normal oestrogen amount circulating in your body. Some women will experience breast tenderness, abdominal bloating and / or nausea as a result. Most feel no different.

• Ganirelix (Ovaleap, Meriofert, Rekovelle)Ganirelix is the drug most commonly used to prevent ovulation during stimulation. It does not usually produce any side effects.
• Buserelin Zoladex, ProstapBuserelin (Suprecur), Goserelin (Zoladex) and Luprorelin (Prostap) can cause some symptoms when used in IVF cycles. These are used in long protocols (uncommon, nowadays) to provide a longer acting switch off in the pituitary gland. When used alone they can cause hot flushes, night sweats and sometimes exaggerated changes in your mood (e.g. tearfulness out of the ordinary). Note that Buserelin used once to trigger ovulation in a short protocol does not cause any side effects.
• Cyclogest / LubionCyclogest pessaries deliver progesterone into the vagina where the hormone is absorbed by the bloodstream. The hormone is bound in a waxy substance which is solid at room temperature but liquid at body temperature. You will notice a greasy discharge whilst using these medicines. We recommend you insert them before bed, use a panty liner and go to sleep! Do not worry that the medicine is coming out – it is not. Progesterone can cause water retention (bloating). You are likely to feel a little bloated after your egg collection anyway. Please take these side-effects in your stride.

  Progesterone is also delivered by injections (Lubion). These medicines do not have additional side effects beyond the above.

7.1 Can I freeze spare embryos?

All surplus embryos of suitable high quality will be frozen for your future use if you choose to do so. Unless you have NHS funding in place, there is a cost for freezing and storing embryos that will need to be paid on or around the day of transfer.

7.2 How long can my eggs / sperm / embryos be stored for?

Eggs, sperm and embryos can now be stored for up to 55 years. Most people will obviously not need them to be stored for so long. The clinic is required by the HFEA (Licensing Authority) to monitor all eggs / sperm / embryos that we have stored to make sure you still want and need them to be stored. We will contact you periodically if you have not contacted us to discuss what you want to do with your stored eggs, sperm or embryos. Legal consent needs to be renewed at these intervals.

Eggs / Sperm / Embryos that you no longer need for your own treatment can be managed in several different ways including humane disposal, donation for another patient and donation for research and training purposes. We will discuss this in more detail if and when it might apply.

8.1 How do I get NHS funded treatment / what are the access criteria?

To access NHS funded treatment you must first ask your GP to refer you to a Sub-Fertility clinic for investigations, following which an onward referral will be arranged for eligibility criteria to be checked and onward treatment. Here at Hull & East Riding Fertility, we hold a contract for Sub-Fertility Services and therefore we can ensure your treatment from GP referral all the way through a full treatment cycle is a seamless process.

NHS funding for assisted conception (the group term for fertility treatments) is not the same throughout the country. It is determined by the Integrated Care Board (ICB) that your GP is registered to. You can look up your ICB here https://www.england.nhs.uk/contact-us/about-nhs-services/contact-your-local-integrated-care-board-icb/ Please remember it is based on your GP’s postcode and not your home postcode.

Currently all ICBs in our area fund at least one cycle of IVF but all are subject to access criteria which can be found in the Yorkshire and Humber Access to Assisted Conception Policy hyperlink https://humberandnorthyorkshire.icb.nhs.uk/wp-content/uploads/2023/07/Access-to-infertility-treatment-Commissioning-Policy-Document.pdf These include the duration of your relationship (treatment of single women is not currently funded), cohabitation, no previous children for either partner, neither partner having been sterilised, the woman wishing to carry the pregnancy must have a body mass index (BMI) under 30kg/m2.

8.2 How much does IVF treatment cost?

The cost of the various elements of IVF treatment is fixed and can be easily calculated once it has been established which elements you require. The cost of the medication varies significantly from patient to patient because different doses are used for different lengths of time.

The clinic will provide you with a costed treatment plan once it has been decided to proceed.

A rough ballpark figure would be £6000-7000 per cycle of IVF, including the medication. Please visit our fees page for more information https://www.hulleastridingfertility.co.uk/fees/.

We partner with Access Fertility who, as well as offering packages to make treatment more affordable, also offer financial assistance to help spread the cost of those packages. If you choose to buy an Access Fertility package all treatment is carried out at our clinic by our team of fertility experts. For further information on our partnership with Access Fertility and the packages they are able to offer please visit https://www.hulleastridingfertility.co.uk/treatments/access-fertility/.

8.3 Can I pay for my treatment in installments?

Although we don’t have direct finance packages available, if you choose an Access Fertility package there is an opportunity to spread the cost of your treatment.

If you are paying the clinic directly, payment needs to be paid in full before each treatment cycle commences.

8.4 When do I need to pay for appointments and investigations?

Payment for an appointment, service or investigation must be paid 48 hours in advance of the event,

8.5 I need to cancel an appointment; will I still get charged?

We understand that there are times when unexpected events result in you having to change or cancel appointments; to ensure no charges are made, please ensure you inform the clinic 48 hours before the planned appointment time. Unfortunately if you do not let us know, or do not turn up for appointments, you may still have to pay. If, due to emergencies, it isn’t possible to give us 48 hours’ notice, please contact us as soon as possible and we will do our best to make suitable alternative arrangements.

If you are an NHS funded patient and do not turn up for appointments, you may lose access to funding or be discharged back to your GP. Please let us know as soon as you can if an appointment is no longer needed or convenient.

8.6 I’m an NHS funded patient; can I pay for additional services privately?

Although there are strict rules within the NHS which mean you cannot split the cost of a treatment cycle itself between privately and NHS funded, if you wish to pay for additional services in advance of your treatment starting, such as additional blood investigations, a 3D scan or pay for the use of Embryo Triple Check, these are options available to you and can be self-funded.

9.1 What is a Hydrosalpinx?

A hydrosalpinx is the medical term for fluid (water) in the fallopian tube. The tubes should not be visible on ultrasound. If there is evidence of a fluid pocket in the area of the tube further evaluation is required. This will usually mean a laparoscopy operation under general anaesthetic with a view to having the damaged tube(s) removed. Fluid can get stuck in the tube as a result of inflammation due to infection. Chlamydia infection is the commonest (but not the only) cause. If the tube has been damaged in this way it can have a detrimental effect on the chance of success with IVF because the the inflammation and / or fluid can make the womb hostile to the implantation of an embryo.

The chance of a successful IVF pregnancy is reduced by 50% in the presence of a hydrosalpinx.

9.2 What is a Fibroid?

A fibroid is caused by the abnormal growth of fibrous tissue cells within the muscle fibres of the womb. They can be tiny (the size of a grain of rice) up to the size of a melon. They can be solitary or multiple. They are not cancerous. They are very common and do not cause problems for many women. They are only very rarely responsible for infertility when they block the fallopian tubes or they affect a large part of the womb lining making implantation of a pregnancy difficult. Fibroids that project into the womb lining will sometimes need to be surgically removed (keyhole or hysteroscopic surgery).

Large fibroids can cause abdominal swelling and discomfort. They can be troublesome in pregnancy. Removal involves major surgery (laparotomy or laparoscopy). We will discuss the pros and cons of surgery and refer you on to an appropriate expert surgeon if necessary.

9.3 What is an Ovarian Cyst?

A cyst is a pocket of fluid. The ovary produces a cyst every month as a new egg gets ready to ovulate. These cysts are also called follicles. Sometimes when the mechanism of egg development and ovulation goes awry, cysts can stay around in the ovary for longer then usual. This can happen during the first few months after stopping hormonal contraception and at the extremes of reproductive life (including peri-menopause). This is also the case in polycystic ovary syndrome. These kinds of cysts are harmless.

Other types of cysts can form in the ovary as a result of abnormal function or disease. Endometriomas are ovarian cysts containing endometriotic tissue. These don’t disappear on their own. Sometimes surgery is advised, depending on their size and symptoms the disease may be causing.

Dermoid cysts are another type of benign cyst that can form in the ovary. These cysts can contain strands of hair, bits of bone, tooth, cartilage, and other rogue tissues, coated in greasy or runny fluid. They can grow bigger over a long period of time.

Both endometiomas and dermoids can make egg retrieval more challenging and risky. Puncturing one of these cysts at the time of egg retrieval can cause serious pelvic infection.

Large cysts >4cm are at risk of ‘torsion’ where the ovary spirals around its blood vessel stalk. This causes sudden and severe pain and is a medical emergency. If the ovary is not untwisted quickly (within hours) it may end up needing to be removed to prevent gangrene (necrosis).

10.1 I’m using donor eggs, sperm or embryos. What can I find out about the donor?

When choosing an egg, sperm or embryo donor you can have access to various non identifable factors about the donor:

• Physical description: e.g. height, weight, hair color, and eye color.
• Background: year and country of birth, and ethnicity.
• Medical history: both personal and family medical history, including any significant inherited conditions.
• Other details: marital status, whether they have had children, and if so, how many and their gender.
• Personal message: a personal description, interests, or a goodwill message to potential children, if the donor has chosen to provide one.

The law on anonymous donation changed in April 2005, which means when a child born from a donor reaches 18, they can have access to identifying information, such as the donor’s full name, date of birth, and last known address, which may allow them to contact the donor.

10.2 I’m wanting to be an egg, sperm or embryo donor, what can the recipient/child find out about me?

When a patient is choosing an egg, sperm or embryo donor they can have access to various non identifable factors about you (the donor):

• Physical description: e.g. your height, weight, hair color, and eye color.
• Background: your year and country of birth, and ethnicity.
• Medical history: both personal and family medical history, including any significant inherited conditions.
• Personal message: a personal description, interests, or a goodwill message to potential children, if you as the donor, choose to provide one.

The law changed on April 1, 2005, in the UK, ending anonymous donation. When the child reaches the age of 18, if requested, they can have access to your identifying information, such as your full name, date of birth, and last known address, which may allow them to contact you.

This change in the law does not mean you will have any financial or legal parenthood responsibilities.

10.3 I’m wanting to be an egg/sperm donor, will I get paid?

In the UK it is not lawful to pay someone to be an egg or sperm donor. Donors can, however, receive compensation for reasonable expenses incurred during the donation process. For sperm donation, this is up to £45 per clinic visit, while egg donors can receive up to £985 per donation cycle to cover costs.

11.1 What is Time-lapse Imaging (Embryoscope)?

The Embryoscope is a sophisticated type of incubator (oven) for growing fertilised eggs (embryos) in the laboratory. Embryos are obviously small and delicate and need a special and stable environment in which to develop. This machine provides a closed environment where the temperature and oxygen levels (amongst other things) are carefully controlled. Furthermore, the machine has built-in cameras that record images of the embryos every 10 minutes around the clock. This provides real-time data to help work out which embryos may be ‘stronger’ or more likely to develop into a healthy baby. It also means that the embryos do not need to be disturbed for examination until one needs to be selected for transfer on its 5th day of life. Embryoscopes are used in virtually every IVF clinic in the UK now. The HFEA has classified their use as an ‘Add-On’ meaning that they are not essential to achieve a good outcome from treatment. This means that the evidence that the machine improves the chances of a healthy live birth in the end is not strong, but it might help. They attract an additional cost.

We believe the technology is also useful to assist with the selection of the stronger performing embryo and therefore, if your egg reserve is strong and you are likely to produce several embryos it may give you an advantage in your treatment.

Here at Hull & East Riding Fertility we use Embryo Triple Check which combines the expertise of our embryologists, Time Lapse imaging and AI precision to select the best embryo for transfer.

11.2 What is Embryo Glue?

Embryo Glue is a commercial product that contains hyaluronic acid. Hyaluronic acid is found in anti-wrinkle face creams because it attracts water and plumps up the skin. It has become common place in IVF to coat the embryo in this product just before it is transferred in order to make the embryo ‘sticky’ as it is attracted to water, and better able to nest in the womb lining after transfer.

Embryo Glue is classified by HFEA as an ‘Add-on’ meaning that it is not essential to achieve a good outcome from treatment. This means that the evidence that EmbryoGlue improves the chances of a healthy live birth is not strong, but it might help. It attracts an additional cost.

Please refer to our Fee Schedule which details the Add-ons we offer and the costs associated with them – https://www.hulleastridingfertility.co.uk/fees/

For The HFEA’s information on Add-ons please see – https://www.hfea.gov.uk/treatments/treatment-add-ons/

11.3 Can I use complimentary therapies during my IVF treatment?

Some women chose to have acupuncture during IVF treatment. We do not encourage this or advise against it. The scientific evidence for benefit is weak. However, it does not appear to do any harm. Therefore, it is up to you if you wish to use it. The same applies to things like reflexology and Reiki.

Chinese medicines/herbs: we do strongly advise against using Chinese medicines many of which contain active ingredients, but they are untested and unregulated. There have been warnings about the risk of contamination with heavy metals like mercury and lead which are dangerous / poisonous. China has undergone very rapid industrialisation without the regulation we enjoy in the West. Factory effluent may contaminate rivers that irrigate farms producing herbs downstream. Please avoid them.

12.1 I am struggling to cope with the stress of not getting pregnant / going through treatment, what help can I get?

We understand that any infertility journey can be a very stressful and emotional time. We have formed partnerships with a number of highly qualified, specialist fertility counsellors. NHS funded patients are entitled to 3 support counselling sessions from the start to the end of a treatment cycle and privately funded patients’ treatment fee includes the same. If you have bought an Access Fertility package, counselling sessions are still available, however this is charged separately and per session from the package you have arranged with Access Fertility.

13.1 What are your success rates at HERF?

Clinic success rates are published with variable denominators (e.g. positive pregnancy test per embryo transfer, clinical pregnancy rate per cycle started, live birth rate) which can make it difficult to judge and compare. The licensing authority, the Human Fertilisation and Embryology Authority (HFEA.gov.uk) requires all treatments involving the use of eggs and/or sperm outside the body to be registered. It publishes all UK clinic success rates. HERF has been providing assisted conception services since 1990 and has consistently maintained or exceeded the national average success rates.