A careful medical and surgical history via consultant precedes investigations. Following that, in order to fully assess we suggest a full endocrine profile and AntiMullerianHormone followed by progesterone levels in the midluteal phase-after ovulation.
We then suggest evaluation of the uterus and tubes by pelvicultrasound(we suggest transvaginal as this offers the best views). We can perform 3D scanning or HyCosy scans to assess the uterine cavity and HyCosy/Hysterosalpingogram to assess the tubes.
If your history indicates, eg painful periods we may advise laparoscopy as an assessment of the pelvis and tubes and/or hysteroscopy to assess the cavity of the womb.
Whilst stress, sleep and lifestyle factors have been historically difficult to prove as the primary cause of subfertility, there is now emerging evidence of a link-couples who have difficulty with sleep may take up to six months longer to conceive(see Evening Standard-29/6/17). The team at Natility can help with this with a combination of mentoring, psychotherapy and hypnotherapy.
It has been long known the couples at the extremes of weight and exercising can have an increased rate of subfertility and we can guide you with the expertise of the multidisciplinary team.
We can also offer investigation and evidence based treatment of recurrent miscarriage. We will use the most up to date, evidence based (association of Early Pregnancy, RCOG and NICE guidance) approach. There is evidence that weekly scanning in early pregnancy provides support and reassurance that increases the chance of a live birth. Whilst, this is difficult to source in the NHS, we are happy to provide this up to 12 weeks gestation.
The management of the commonest forms of subfertility in women are outlined below:
This is one of the most common causes of subfertility and can affect 1in 5 women but prevalence is higher in women having difficulty conceiving.
Whilst, the RCOG recommended first step in the management of PCOS are conservative measures to improve natural cycles, reduce symptoms and risks and enhance fertility, women are often battling against a ticking biological clock by the time that they present to assisted conception.
The eggs of women with PCOS are relatively immature in their cycle compared with women without PCOS and so conservative and medical treatments are often preferable to assisted conception, and should also be used alongside any treatments.
Optimising hormonal imbalances and muscle mass to fat ratio will not only enhance fertility but also reduce risk of miscarriage once conception has occurred (recognised to be a higher rate with PCOS) and minimise the risk of gestational diabetes in pregnancy with its inherent increased risks to both mum and baby.
With the challenges surrounding a balance of work and lifestyle, ovarian ageing is now one of the biggest causes of difficulty conceiving. Eggs of women with either premature ovarian ageing/insufficiency or in the later age groups (44+) tend to be more fragile and respond less well to invitrofertilization (IVF). In this case natural conception, sometimes with superovulation and/or endometrial scratching can offer a less invasive approach with a similar, if not better, chance of conception.
We can investigate ovarian reserve with Anti Mullerian Hormone (AMH) and offer advice on In vivo treatments for women with more fragile older eggs.
This can cause painful periods and deep pain during sex. We can start investigations by ultrasound and move onto laparoscopic surgical treatment if necessary.
Sometimes life style factors and diet can affect ovulation. We can aid identification of the cause and enable management with dietary, exercise and psychotherapeutic interventions when stress contributes.
In addition to the more commonly recognised difficulties with PCOS, very fit women with restrictive diets and/or high levels of exercise can be affected by Hypogonadotrophic Hypogonadism-a condition that may ‘turn the ovaries off’, make periods infrequent and affect fertility. We can offer both dietary and lifestyle advice to assist in this.
We offer endometrial scratching that has been shown in studies of couples with unexplained subfertility to increase pregnancy rates the following cycle up to 70%. This can either be used as an adjunct to treatments-perhaps before Ovum Donor cycles in overseas clinics or as part of a natural conception package.
This investigation, long felt anecdotally byfertility specialists to improve chances of conception, is now proven to increase pregnancy rates by up to 40% which is similar to IVF and considerably cheaper and less time consuming (as described in The Telegraph June 2017).
132 Harley Street is a new concept in integrated health care. Our aim is to provide exceptionally high quality outpatient services in both traditional and complementary medicine within a calm and supportive environment.
132 Harley Street