We turned to Mr James Nicopoullos, Consultant Gynaecologist and Sub-specialist in Reproductive Medicine and Surgery at The Lister Fertility Clinic, and asked him to introduce us to the brilliant fertility team that a patient meets at each stage of the IVF process.
Your Consultant PA is the first person you meet on your IVF journey
Your first point of contact when you are thinking about coming to see us at the Lister Fertility Clinic is one of our Consultant PAs. You may have a particular Consultant in mind that you have been recommended or have read about or you may just want to see any of our experienced Consultants and the PAs will discuss your preferences and book you in for a Consultant appointment. They will also ask you about any previous tests that you may have had to ensure that we do not repeat anything unnecessarily and their aim will be to try and book the required tests just before you see one of the Consultants so we have all the information at hand when you do come to best be able to counsel you about the best way forward.
Next, you will meet your Consultant
Once you have had this initial discussion and you are happy to proceed our PAs will book you in with one of our experienced Consultants. They will normally book in a transvaginal scan to assess any anatomical problems and egg reserve a week or so before the appointment, and perhaps book in an AMH to test egg reserve and the semen analysis if appropriate. Armed with these test results they will book you in to see one of our Consultants either face-to-face or virtually via Microsoft Teams, whichever is most convenient for you.
At that hour long appointment the Consultant will review your personal history, any previous investigations or any previous treatment cycles you have had, and based on that help diagnose what might be the issue, counsel you about the various options available to you including using our extensive statistical database to help personalise your chances of success with any treatment we offer. Often by the end of the consultation a clear pathway will be in front of you or alternatively further tests may be required, or you may want some time to go away and review the information given to you before coming back for a follow-up consultation to make any final decisions.
We often supplement the discussion with written information via our online portals and a plethora of written patient information leaflets to help you decide. We will also give you a personalised costed treatment plan, which is a regulatory requirement once the decision is made to proceed with IVF, to ensure you have an accurate assessment as possible as to what any treatment may cost moving forward.
Your nurse practitioner will begin your pre-assessment appointment
Once a decision is made to proceed with IVF, perhaps the first and most important next step is to see one of our experienced nurse practitioners for a pre-assessment appointment. At that appointment the nurse will ensure you have all the information you need and answer any questions that have come up, ensure that you have happy with all the consent forms that you would have completed via our online portal, ensure all the required tests have been done and are in place, teach you how to do the requirement injections and discuss with you the options with regards to your medication.
As one of a few clinics with a pharmacy onsite we recommend our patients either collect the prescription upfront from our pharmacy or we can arrange for it to be couriered. You will also always have access to your lead Consultant by email, so if you have any queries at any point during the process this is always an option available to you.
You can call your nurse or consultant with any problems
At any point if you have any problems with injections or medication before you start you can email the nurses directly or your Consultant with any medical queries and during the treatment the nurses are always available during working hours to call or email. We also have an emergency phone that is available until midnight to ensure any out of hours problems are covered.
The sonographer will carry out your scans
When you start treatment you will call us on the first day of your period more often than not to book in a scan with one of our experienced sonographers or a nurse sonographer. The aim thereafter is to have as much continuity as possible and we will often book the remaining scans for you with the same sonographer. The scans will subsequently be reviewed by a nurse practitioner, who will also perform blood tests for you and the scans and bloods will be reviewed at the end of the day by one of our Consultant team who will ensure we do not need to change any dosing or any of the decisions made earlier in the day.
Your consultant will carry out your egg collection
Once you are ready for egg collection it is imperative that your eggs are collected, or your embryos transferred, at absolutely the right time to maximise your outcome and not necessarily at a time that is perfect for any individual doctor. We always endeavour where possible for your lead Consultant to carry out your egg collection, but it can be very variable between perhaps 10 to 16 days in terms of how many days before somebody is ready for an egg collection, so the egg collection lists are shared between all the doctors. If your lead doctor is in that day, and most work full-time, they will of course do their best to ensure they can do the procedure for you. Throughout the process that lead Consultant is always available to discuss any queries by email if you have not seen them on the day you come in.
A Senior Embryologists will ask the male partner to come in for sperm collection
When the male partner comes in for a sperm collection on the day of egg collection, he and his partner will be in one of the private rooms on the ward waiting for egg collection. He will get a call from one of our senior Embryologists who will ask him to come down to the IVF Unit to produce a sample. The receptionist will be aware of this and he will book in via the receptionist on the IVF Unit and one of the Embryologists will come and collect him from the waiting room, make sure the paperwork is complete, and guide him to the sperm collection room and makes sure he knows exactly what he needs to do and what happens next.
Inside the Embryology Lab
Once the eggs have been collected they are passed up to our Embryology Lab where they will prepare them for either insemination with IVF or sperm injection with ICSI, having also prepared the sperm sample and ensured all the best swimmers are available for the process. With standard IVF in essence the Embryologists leave a high number of good quality sperm with each egg in the right culture conditions overnight to allow natural selection and the best sperm to ideally fight it out to fertilise the egg. Where there are issues with sperm quality we will often perform ICSI, where an individual moving normal looking sperm is injected into the egg. This is done on the day of the egg collection and whichever mode of fertilisation the Embryologist assess the embryos the day after egg collection to see how many have fertilised and can be grown on and cultured in the lab.
Over subsequent days the embryos are cultured for as long as it takes to be able to select the best and most suitable ones for transfer. The aim, as always, is to push the embryos to Day 5 or blastocyst stage, as again through a natural selection process those who survive to Day 5 are most likely to be genetically normal and most likely to achieve a pregnancy. The Embryologists will keep you updated throughout that 5 day period initially calling you the day after egg collection to let you know how many have fertilised, calling on Day 3 to inform you of how the embryos are developing and helping you decide between a Day 3 and a Day 5 transfer and then booking you in for a transfer. Throughout that time they are also available to be contacted as needed, as is your lead Consultant. If you are considering genetic testing of embryos this will also be discussed again at this stage
When the embryos are suitable for transfer, as with the egg collection, it is essential that it is done at a time that suits you the best and if your lead Consultant is available they will of course endeavour to do the transfer. The consultant along with the Embryologist will outline again whats happened through the cycle, discuss the embryo quality available helping you decide between one versus two embryos to try and maximise the outcome, while minimising the risk that come with a multiple pregnancy
The counselling team are there for you during the Two Week Wait
Throughout the IVF process you are always on the go with regular scans, daily injections and to be suddenly left to your own devices for a 9 to 10 day wait (test is always 2 weeks after egg collection) to find out if you are pregnant is often the hardest part of the journey. This is made worse by the high levels of progesterone you are being given, which in essence is also the hormone that triggers premenstrual like symptoms. Throughout that time we are always available to contact with any queries and our counselling team is there before, during and after this period to maximise support. It is key that you access this as needed and this is not something that is ever charged for at the Lister, which is unique.
On the day the test is due, which is normally 2 weeks after an egg collection, you can either perform a urine test at home or come in for a blood test, and we often recommend repeating 48 hours later for certainty and ask you to call us to confirm the result either way, at which point we will let you know what happens next in the happy event of a positive test and what medication to take and recommend booking in a follow-up appointment with your Consultant if unfortunately the result is negative.
If you would like to speak to anyone at the Lister Fertility Clinic, simply click here.
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