Treatments

Fertility Exeter has a multidisciplinary team of staff consisting of Doctors, Nurses, Embryologists and Counsellors who can help to determine the cause of, and map out the most effective solution to your subfertility. This may include a number of tests and investigations to help with the diagnostic process.

This is a test to check the ‘quantity’ of sperm, which gives an indication, although not an absolute assessment, of fertility potential. It involves looking at a sample of semen under the microscope to see how many sperm are present, what proportion are moving well and appear ‘normal’ in shape.

Routine follow-up post-vasectomy samples are analysed in the Cytology department.

Fertility Exeter may undertake further checks, for post-vasectomy samples, where specifically requested by your doctor, to look at the number and movement of sperm that may be present.

Tubal blockage or adhesions affect up to a third of women experiencing a delay in getting pregnant. There are three ways of checking whether fallopian tubes are open (patent):

• An operation called a laparoscopy and dye test
• An X ray procedure called an HSG (hysterosalpingogram) available for NHS funded patients
• A contrast tubal patency ultrasound called a HyCoSy scan is offered for self-funded patients

In some cases, the woman can have these tests done on the NHS but not everyone is eligible for NHS funding.

NHS funding depends on your individual circumstances and the ICB for your GP’s surgery. All of those policies are on your local ICB’s website. If you aren’t eligible for NHS funding, you can opt for self-funded tubal patency testing.

At your initial consultation in Fertility Exeter, the doctor will take a clinical history and assess your risk of having tubal disease.

We will arrange for a blood test to screen for past silent Chlamydia infection. If your Chlamydia blood test is negative, then your chance of tubal blockage is less than 10% and tubal patency testing with a HyCoSy scan or hysterosalpingogram is recommended.

If your blood test is positive, then your risk of tubal blockage or adhesions may be as high as 60-70% in which case we would recommend a laparoscopy and dye test. The advantage of a laparoscopy and dye test is that it is better at diagnosing adhesions and often surgery can be done at the same time to break down adhesions or open the tubes up. The disadvantage is that it is an operation and it carries a small chance of potentially serious complications.

SSR is a method for obtaining sperm directly from the testicles. It would normally be required for individuals who have been born with or developed a blockage of the tubes which transport sperm away from the testicles (including post-vasectomy). It may also be appropriate for those with medical issues affecting ejaculation. The methods used at Fertility Exeter are PESA (percutaneous epididymal sperm aspiration); TESA (testicular sperm aspiration & TESE (testicular sperm extraction / biopsy) and will depend upon which is the most appropriate for an individual’s circumstances.

IVF is the process of attempting to create embryos in the laboratory outside of the body. Eggs are harvested from the ovaries after taking hormones to stimulate egg development. These eggs are then mixed with sperm in an attempt to create embryos (fertilised eggs) which can then be replaced in the womb two to six days after egg collection with the hope of conception. The law relating to IVF limits the number of embryos that can be transferred in each cycle, so where high quality embryos remain after embryo transfer, cryopreservation may be an option to conserve for potential future use.

Formally known as preimplantation genetic diagnosis (PGD), which helps couples who are at a high risk of having a child with a serious genetic condition. This is a special type of in vitro fertilisation (IVF). Embryos are created outside of the body and are tested for the specific genetic condition. Only embryos which are not affected by the genetic condition are placed into the womb. We can test for more than 300 genetic disorders, including conditions such as cystic fibrosis and Huntington disease. We run a satellite service with Guy’s and St Thomas (GSTT) Hospital in London. GSTT is the largest PGT centre in the UK and one of the most successful centres in Europe. We are a multidisciplinary team consisting of Fertility Consultants, Genetics Consultant, Genetic counsellors and Fertility Specialist Nurses. Since the Exeter service began in 2015, 46 babies have been born, with this treatment.

ICSI is an additional process in IVF where single sperm are selected from the processed semen sample and using specialised micromanipulation equipment, insemination of each suitable egg is achieved through injection with an individual sperm. This is offered for couples where sperm function is likely to significantly increase the risk of poor or complete fertilisation failure with standard IVF practice.

Where embryos have been suitable to cryopreserve after an IVF cycle, frozen embryo replacement can be considered. Typically, the lining of the womb is prepared with a series of hormone drugs to optimise receptivity of the womb lining prior to warming of the embryo/s before replacement.

IUI involves using a catheter to put washed, prepared sperm near the top of the cavity of the womb around the time of ovulation to increase the chance of getting pregnant. This is usually combined with ovulation induction drugs to ensure optimal timing of IUI. Partner’s sperm or frozen-warmed donor sperm can be used.

Donor insemination is used for both IVF and IUI treatments where screened and prepared donor sperm is required to assist conception.

Sperm banking is a process of freezing and storing sperm for short or long periods of time. Sperm are first mixed with a special fluid to help protect them from the harmful effects of freezing before being frozen and stored. Banking is indicated when there are factors likely to affect future fertility once puberty has been reached (e.g. treatment for cancer or conditions needing drugs known to cause fertility problems or abnormalities in pregnancy). Sperm banking can also be provided for couples undergoing assisted conception where absences during treatment may be expected and for individuals seeking male to female gender reassignment.

Egg banking is a process of preserving and storing eggs for short or long periods of time.  The eggs are obtained in a similar way as for conventional IVF for those who have reached puberty. Harvested eggs are mixed with a special fluid to help protect them during the process of being frozen and stored. Egg banking is mostly commonly accessed at Fertility Exeter by those who are facing cancer or other medical diagnosis, those seeking female to male gender reassignment or for social reasons.