Insemination using Donated Sperm

We will endeavour to start your treatment as soon as possible, but occasionally to ensure safety within the laboratory, and to always maintain our high standards; we may not be able to allow you to commence treatment immediately. You should only have to wait one month.

General Health and Diet

PRIOR TO TREATMENT

In the three months prior to starting any stimulation drugs we would advise that as a couple you should consider the following recommendations:

SMOKING
Smoking can be dangerous during pregnancy and can also decrease your chance of conceiving. Therefore it is imperative that neither of you smoke.

ALCOHOL
Alcohol should be kept to a minimum (less than 5 units per week) for both partners.

CAFFEINE
Caffeine intake should be reduced. Caffeine can be present in coffee, tea, cola and chocolate.

DIET
A healthy eating plan we believe to be helpful is to avoid snacking between meals (including 'healthy' snacks i.e. fruit, muesli bars, fruit juices and smoothies). If you want to eat these types of foods add them into one of your 3 meals a day. Meals should always have some protein content i.e. fish, eggs, meat, cheese or pulses. Try to keep the carbohydrate content in each of your meals lower than the amount of protein e.g. Instead of a large bowl of pasta with small amount of protein, change and have a portion of meat or fish with small side helping of pasta or rice or potatoes. We also advise that you avoid soft cheese, pate, liver, sword fish and shell-fish from the day of treatment

FOLIC ACID
You should take folic acid 400 micrograms daily from 3 months before the scheduled treatment cycle. This is a Department of Health advice for all women wishing to conceive and not just for assisted conception treatment. This vitamin has been shown to reduce the chance of spina bifida and is available from chemists. You should continue with it for as long as you are trying to conceive and for the first three months of pregnancy. Also it is good advice to eat a balanced diet with plenty of vegetables and raw fruit. We would recommend taking folic acid combined in with a multivitamin product specific to pregnancy.

WEIGHT
Normal body weight for both partners will increase your chances of success. We will work out your body mass index for you and advise you whether you should lose weight. Equally a low body mass index can also reduce success. There are individual situations when it may not be possible to start treatment until there is a weight reduction.

SCREENING
We will need hard copies of the results of various tests to be in place and in date before you can commence treatment. A list of those will have been sent to you with your initial consultation documentation. They need to be repeated annually. Your GP may possibly help with screening but if this is not possible, we can arrange all your screening to be done here.

DURING TREATMENT

FLUID INTAKE
It is important, particularly during the stimulation drugs, that you drink plenty of fluid. We advise all women to drink 2 litres of water from the beginning of the period in which they are commencing treatment.

EXERCISE
Gentle exercise during treatment is good. Please avoid high impact exercise. Walking, Pilates, yoga etc. are excellent ways of keeping mobile. Swimming is also excellent although probably not advised following insemination. There is a small study that has shown an increase in miscarriage rate possibly following infection picked up in public pools. Please ask a nurse if you are uncertain what you should or shouldn't do.

ALTERNATIVE THERAPIES
Please avoid all Chinese medicines and some aromatherapy oils during treatment. Some of the medicines may actually be harmful, as are certain oils used for aromatherapy. Many of our patients have acupuncture and we have information in the waiting room. Please help yourself.

We would recommend that carrying on with as normal life as possible will help you both to keep the balance of treatment in perspective. Taking lots of time off work is not necessary unless there is a clinical indication to do so. We will advise you when that is recommended.

Remember that you may need to have more than one treatment cycle. Many couples will need at least 6 cycles before they achieve an on-going clinical pregnancy.

PRE-TREATMENT ASSESSMENT SCAN
It is important that all aspects of tailoring your treatment are undertaken to give you optimal chances of success. Before you commence your first treatment cycle a pelvic assessment scan will be undertaken. This allows us to look at your ovaries in order that we are more able to judge the correct dosage of stimulating drugs you will require. We will also look at your womb and assess the uterine cavity to exclude fibroids and any other anomalies. This is a chargeable scan and not part of your cost of treatment, however it will usually only need to be done once. This scan is particularly helpful for those patients who may have polycystic ovaries and require other oral medication during the treatment cycle.

IMPLICATIONS AND COUNSELLING APPOINTMENTS
Anyone seeking treatment here will be required to come in to the clinic for an information (implications) session covering all aspects of their treatment. This appointment is mandatory for anyone having treatment with donated sperm. One of our fertility nurses will discuss with you the clinical and legal implications of your treatment before you sign your consent forms. The appointment is arranged for either a Tuesday or Thursday and couples will need to attend together. You should expect to be here for at least 1 hour and you will have a chance to ask questions. An appointment with our counsellor is also mandatory prior to treatment. This appointment is often prior to your initial consultation and is an opportunity to discuss the implications for each other, any existing children and any child born as a result of your treatment. You are again required to attend as a couple.

Consent

Prior to commencing treatment, consent forms must be signed. There are several consent forms to sign. These include taking consent for insemination with donated sperm and where necessary HFEA forms consenting to legal parenthood.

We will also discuss the process of selecting a donor and in due course you will need to sign a form confirming that you wish that particular donor to be used for your treatment.

You will be given plenty of time to read and ask questions about all consent forms before signing. A nurse will guide you through the consents so that you fully understand the documents you are signing.

What to expect during your treatment cycle

When you are ready to start treatment (all screening tests are in place and consents completed) please telephone the Victoria wing on day 1 of your period. If your period commences over the weekend call us between 7.30 and 9am on the Monday morning. We will arrange for you to come in for a baseline scan (usually between Day 2 – 4 of your period) following which one of the nurse specialists will explain about your treatment and you will collect your drugs from pharmacy. Another scan appointment will be booked for you before you leave the clinic. Injections may be daily or alternate days dependent on which protocol is most suitable for you. This will be discussed after the first scan. It is important that all your screening results are available and in date (within the last year) so please check this before starting treatment.

BASELINE ULTRASOUND SCAN
Attend for your baseline ultrasound scan as instructed. The scans are performed with a vaginal probe and therefore a full bladder is not required. This scan will be performed even if you are still bleeding. If your scan shows any persisting cysts or follicles in the ovaries or if the lining of the uterus (endometrium) is too thick a sample of blood for Oestradiol assay may be collected at the same time. Depending on the level of oestradiol your cycle may be deferred until the following cycle.

FOLLICLE – STIMULATING HORMONE (FSH) INJECTIONS
Once the baseline scan has confirmed that there are no contra-indications to starting the FSH injections the nurse will confirm the day to start them and also the dose to take. The starting dose of the drug will have been decided in advance by your consultant and will depend on your age, baseline hormone results and responses to any previous stimulated cycles. FSH is usually prescribed as Menopur although there are alternatives. You will be given a medication chart to take home with this information in writing – remember to bring this back with you to each scan for the nurse to write down the continuing dose which will depend on your response. These injections should be at the same time each evening.

CONTINUED FOLLICLE MONITORING
(Progress Scans) In order to monitor the response to FSH injections you will need to attend for further scans on certain days. Some of these appointments for scans are possible to predict in advance but please do be prepared to have to alter the days of scheduled attendance if the response to the injections is not as we had predicted.

We will use the results of the scans (and possibly blood tests) to adjust the dose of FSH injections and to determine the date and time of the final injection of hCG (Pregnyl) 10,000IU. This injection of hCG matures the eggs within the follicles and stimulates ovulation. Depending on the follicle size we will sometimes also ask you to test for the presence of LH in your urine (LH surge) Throughout this phase it is important that we can contact you easily. There will be further instructions as you go along. In order to assist staff - please bring the medicine chart with you whenever you attend.

SIDE EFFECTS OF DRUGS
The FSH injections stimulate the production of follicles and hormones within the ovary. Whilst receiving these injections some women experience breast tenderness, increase in vaginal secretions and abdominal distension. If their ovaries over respond, this abdominal distension may be considerably more uncomfortable. Sometimes the injections cause local skin irritation. The majority of women do not experience any side effects, and if they do they are usually short lived and will cease when the treatment is finished.

Very occasionally the ovaries will respond much more than anticipated and there will be a risk of developing Ovarian Hyper Stimulation Syndrome (OHSS) – See OHSS section.

INTRA-UTERINE INSEMINATION
Your insemination will probably be on or about the day that we have planned for, but the precise day may vary according to how the ovaries respond to the FSH injections. Depending on a number of factors (follicle size, day of cycle, presence of LH surge) insemination may be timed for the same day or day after LH surge; or 1 to 2 days after the hCG injection. Insemination will occur in the Victoria Wing, is usually a simple painless procedure lasting 5 to 10 minutes and does not require a general anaesthetic. The procedure is performed on an outpatient basis. Your name and date of birth will be checked with you. We will also ask you to check the labels on the ampoule containing the donor sperm and the details of the donor used with the choice that you have previously signed for. Please be reassured that all stages of sperm selection and preparation are witnessed and confirmed by two people. In some circumstances there is insufficient response and the cycle is abandoned. Other times it is possible to have over stimulation of the ovaries; it is not possible to perform IUI when there is over stimulation because of the risks of multiple pregnancy. These possibilities will be discussed with you at your implications counselling appointment.

FOLLOW UP
We will advise you when to do your pregnancy test (usually 16 to 17 days after insemination). During this time you may experience increased discharge from the vagina and some low abdominal pain. If you have concerns about any symptoms you are experiencing contact the ACS unit. Please avoid using commercial pregnancy tests as the results can be misleading. If the pregnancy test is positive you will be offered a scan – this is usually booked two to three weeks after the pregnancy test date. The scan is to confirm that the pregnancy has continued to develop. Unfortunately about 15% of pregnancies will miscarry, with a small chance of an ectopic pregnancy. If the test is negative, an internal review will be carried out by the nurses, embryologists and your consultant to review what should happen with your next cycle. This will then be relayed back to you by telephone or letter. On some occasions we may recommend a review for you with your consultant.

OVARIAN HYPER-STIMULATION SYNDROME (OHSS) – IT IS EXTREMELY RARE FOR OHSS TO DEVELOP WITH IUI TREATMENT
If the ovaries over respond to the FSH injections and a large number of follicles develop there is a risk that OHSS may develop. When there are a large number of follicles it is possible that the ovaries will enlarge and release chemicals into the bloodstream that make blood vessels leak fluid into the body. OHSS is classified as Mild, Moderate or Severe.

If there are signs of moderate to severe OHSS prior to the treatment you may be advised not to have the trigger injection, and your egg treatment will be cancelled. You will need to start down-regulation drugs until all the follicles have collapsed. Once this has happened, a new cycle of treatment with a lower dose of FSH injections can be restarted.

The most severe form of OHSS only occurs in 1 – 1.5% of patients receiving fertility injections. It is characterised by nausea, vomiting, ovarian enlargement and ascites, causing marked abdominal pain and distension. The abdominal distension may prevent the proper movement of the diaphragm (the muscle between the chest and abdomen) so that the woman may feel extremely breathless. She may feel weak and faint due to a reduction in her circulating blood volume (hypovolaemia). In the most extreme situations there is a reduction in the blood flow through the kidneys, resulting in a reduction in urine output. If this occurs it may lead to renal failure requiring treatment with renal dialysis.

Those women who develop severe OHSS require hospital admission, usually for a few days, occasionally for longer, to relieve their symptoms and to monitor their progress. Management of severe OHSS may include aspiration of some ascitic fluid from the abdominal cavity. It will include maintaining the circulating blood volume by administering intravenous fluids, which will also substitute the fluids lost by vomiting.

OHSS symptoms can be exacerbated by pregnancy but usually do not persist after the first three months when the hormone production supporting the pregnancy shifts from the ovaries to the placenta. In the majority of cases the symptoms disappear within a few weeks. Those patients who are not pregnant recover much more quickly, usually by the time they have their next period.

The Symptoms you should be concerned about are as follows:

• Abdominal bloating and discomfort
• Heartburn or indigestion
• Reduced frequency of passing urine (we advise drinking 2 litres water daily)
• General feeling of lethargy
• Difficulty in breathing

If you have any of these symptoms please do not hesitate to contact a member of the Victoria Wing nursing team on our EMERGENCY CONTACT NUMBER 07740422717

If admitted to hospital – give the OHSS card immediately to the nursing staff.

RISKS OF MULTIPLE PREGNANCIES
A multiple pregnancy is where 2 or more foetuses develop in the uterus at the same time. Twins or a higher order pregnancy can undoubtedly bring many joys, but both parents need to be realistically prepared for the possibility of potential problems.

A multiple pregnancy will place a much greater strain on the mother and carries a higher risk of miscarriage. Complications (such as high blood pressure or bleeding) are more likely to occur and can arise earlier in the pregnancy. Most multiple pregnancies are delivered early (before 40 weeks). The average length of pregnancy is 37 weeks for twins and 34 weeks for triplets. There is a high rate of caesarean section for twin pregnancies and the majority of triplets are delivered in this way.

The birth weight of twins and triplets is generally lower than that of singletons. Any pre – term baby is more likely to die than one who is born at full term, so twins and triplets are at much greater risk than singletons. Babies who are born very prematurely are also more likely to have complications which can lead to long term problems in the functioning of their lungs or heart and, in particular their brain.

The problems of caring for more than one baby can be considerable and include emotional as well as financial aspects. There are no additional state benefits for multiple births in the UK, yet the everyday costs are much greater. The cost of nursery equipment, clothes, food and childcare is inevitably substantial and many mothers who hoped to return to work after the birth have found the cost of childcare makes this financially nonviable.

Many parents own physical and mental health suffers as a result of caring for twins or more. Depression is more likely and this, like other problems, can affect their relationships with each other, the wider family or friends.

Your consultant and nurse counsellor will discuss these issues with you further but if you have any questions please do not hesitate to ask.

You can also contact the Multiple Birth Foundation: www.multiplebirths.org.uk

With any pregnancy there is a small chance of ectopic pregnancy (3%) The risk of miscarriage is 15% in singleton pregnancies of rising to 21% in triplet pregnancies. If three embryos are transferred, the chance of a triplet pregnancy is dramatically increased as is the chance of miscarriage.

Outcome
For detailed outcome results please see our results page.

Counselling

Our team at the Victoria Wing will give support, before, during and after treatment, providing information and implications counselling and guidance to explore relevant issues. Undertaking treatments can be an emotionally stressful time for you and your partner and it can help to talk things over with someone else. We provide a Counselling Service which is available to every couple or individual attending the Victoria Wing (first six sessions only are free of charge). This counselling is confidential and we would encourage that you make use of this service.

Complaints

If at any time during your treatment you are not happy with the standard of care will you please inform the ACS Manager Caroline Lewis and she will help you as much as she is able.

If you feel however that you wish to complain in writing you please write to the complaints officer, Hospital Director, Nuffield Health Woking Hospital, Shores Road, Woking, Surrey GU21 4BY.

We are constantly striving to achieve excellence within the department; however we appreciate that you may feel there are areas which do not come up to your expectations. We would like to know about this.

What you Need to Know Before Treatment Begins

Before commencing with the proposed treatment, please ensure you have been given the following information.

1. The limitations and possible outcomes of the proposed treatment
2. The possible side effects and risks of treatment
3. The technique involved
4. All alternative treatments
5. The costs involved and costs of any alternative treatment
6. The availability of counseling facilities
7. The possible disruption to your normal life
8. Your General Practitioner is not obliged to prescribe the medication you may require for your treatment
9. Please remember that all screening tests will need to be repeated on an annual basis. Treatment cannot take place with out of date screening

Fee structure

IUI with donor sperm. See prices.

The IUI fee includes all scans, blood Oestradiol level, nursing services, sperm preparation, insemination, and doctor's fees. It also includes one pregnancy test and scan if positive result. It does not include:

• Drugs
• Any investigation required before treatment The donor sperm and storage costs

When to Pay?

Payment must be made in full prior to the treatment cycle commencing.

Cheques should be made payable to Nuffield Health, and all major credit cards are accepted.

We also offer you the facility for 'Banker's Automated Clearing Services' (BACS) which is a simple and cost effective way to make payments directly from your bank account to another bank account. For further information please discuss with our Accounts administrator.

The hospital will require details of a credit card before treatment starts, please discuss this with the ACS financial administrator if this is difficult for you.

H.F.E.A.

The HFEA (Human Fertilisation and Embryology Authority) are the government body that regulate IVF in the UK. A fee is charged for every licensed treatment that takes place.

The fee payable to the HFEA when donor sperm is used – see prices.