UNIT OPENING HOURS
The Unit is open between 8 am and 5 pm, Monday to Friday and 8 am to 12 noon on Saturday and Sunday
Before starting your treatment, we will ask you to sign the relevant consent forms. If seeking treatment as a couple, it is very important that you both understand the forms fully before signing. The forms are as follows:
Consent to disclosure of information – this should be completed by each partner when you attend the clinic and gives us your permission to contact your own general practitioner(s) and any other person concerned with your care. (This is explained in detail under the section on the HFEA).
Consent to treatment (IVF or ICSI).
Consent to use of eggs (and freezing of embryos, where appropriate).
Consent to use of sperm (and freezing of embryos, where appropriate).
We may also offer you a form to consent to the use of eggs which have failed to fertilise, for training embryologists or for research. An example of this type of work is:
Training embryologists to handle human eggs and to learn the technique of sperm injection
DRUGS FOR IVF/ICSI
Purchasing Health Boards have asked us to provide the necessary drugs, and we will supply you with a complete package. Self-funding patients can also purchase all these drugs from the UnIt and this is described in the tariff. The drugs most commonly used in treatment cycles are:
Suprecur (Buserelin) – a nasal spray that suppresses the hormones controlling the ovary. This is referred to as downregulation and a scan will be carried out to confirm this has happened before starting injections of Gonal-F or Menopur to stimulate the ovaries. Suprecur is continued while you are having the injections. Some patients have a problem with nasal sprays and we can provide them with an alternative form which is given as a daily injection (Suprefact).
Gonal-F , Menopur or Bemfola – an injection that stimulates the ovaries. During stimulation, careful ultrasound monitoring is necessary to assess the response of the ovaries by measuring the number and size of the follicles. When the follicles, which should each contain an egg, are the correct size you will be given another drug;
HCG (Ovitrelle) – an injection which brings about final maturation of the eggs.
Crinone gel – support drugs given from the day of egg collection – this is given to support the ovarian function, which has been suppressed by the down-regulation drugs and is continued until the date of the pregnancy test.
NUMBER OF ATTEMPTS AT IVF/ICSI
Should the first attempt fail, we will make further attempts if that is what you wish but if it is decided that further treatment is unlikely to be of benefit, you will be advised of this. Following each cycle, a full review of the outcome will be discussed. For those that are eligible for NHS treatment, you will be entitled to up to two treatment cycles (up to three for patients referred from 1st April 2017), provided you meet the eligibility criteria. Following each cycle, a full review of the outcome will be discussed. If it is decided that treatment is unlikely to be of benefit, further treatment will not be offered and your NHS entitlement will be withdrawn. Transfer of frozen embryos is not counted as a separate attempt. If you are unsure about the number of cycles you are entitled to, please contact Anne McConnell.
RISKS OF DRUGS/TREATMENT
It is important to understand that few forms of medical treatment are entirely without risk. The stimulation drugs can occasionally lead to over-stimulation and formation of cysts which are temporary. In about 5% of all cases, patients over-respond to the drugs with a condition called Ovarian Hyperstimulation Syndrome. This usually settles without any specific measures but can very occasionally become severe with very serious risks to your health. This may require hospital admission and, if we think that there is a high chance of this occurring, we may advise that we freeze all the embryos for later replacement, because we know that the condition can be made worse by becoming pregnant in the treatment cycle. Should you at any time feel that you have abdominal distension, pain, nausea or shortage of breath, then this could indicate that you have developed this problem and you should be in contact with us directly or with your own general practitioner, and do let him/her know that you are aware of the risk.
The technique of egg recovery could inadvertently damage organs close to the ovaries, such as blood vessels, bowel or bladder. These complications are very rare but it is only right that you should be aware of them. Bleeding or infection can also occur but are usually easily managed.
We cannot guarantee that you will become pregnant, nor can we guarantee that any child will be perfectly normal. All the evidence from children born after IVF would suggest that the risks to the babies born are the same as occurs naturally.
There is an increased chance of multiple pregnancy (twins). This is because we usually transfer more than one embryo to the uterus to increase the likelihood of pregnancy. As mentioned previously, we are allowed by law to transfer up to three embryos but we believe that the risks involved in a triplet pregnancy are very real and there is an unacceptable likelihood of premature birth and damaged babies resulting from this.
There is also a risk of ectopic pregnancy, ie a pregnancy occurring outwith the cavity of the womb, the most common site being the fallopian tube. A pregnancy occurring in the tube cannot continue and most often necessitates surgery and removal of the affected tube.
Sometimes we have to abandon an attempt at IVF or ICSI after we have started treatment because the ovaries do not respond as well as expected. This is obviously disappointing for you but we cannot always guarantee that eggs will develop. In most cases, it can be corrected by repeating the treatment with a higher dose of injections.
You can contact the Unit by telephoning the following:
During office hours:
01382 633835 Nurses
01382 632111 Anne McConnell – Business Manager
01382 496475 – Secretaries
01382 660111 Ninewells main switchboard
Out of hours: 07774 694765 Mobile for emergency use – if there is no reply contact the hospital switchboard on 01382 660111 and ask them to contact Dr Kay, Dr Kini, Dr Martins da Silva, Dr Ramalingam or the duty Gynae. Registrar for you.
Folic Acid. There is very real evidence that the incidence of abnormalities of the brain and spine of a baby are greatly reduced if patients are taking Folic Acid at the time of conception and thereafter. Please have a word with your own doctor about this, or you can buy appropriate supplements at any chemist. Please start to take these supplements at any time prior to treatment.
Smoking. There is data available to show that the likelihood of IVF being successful is reduced if either partner smokes. We cannot emphasise too strongly the advantages of stopping at this stage. NHS-funded treatment will not be provided if either partner smokes or is using any for of nicotine replacement therapy.
Rubella. We would expect all patients to have had a check that they are immune to rubella prior to starting treatment.
Aspirin – some patients may be taking Aspirin, although this is not recommended for everyone. It is important that this is stopped around 4 days prior to egg collection.
WHAT DO YOU DO NOW?
The waiting time for treatment will be discussed with you in the clinic. They may also be seen by accessing the “waiting times” page of our website. If you want to enquire about your place on the waiting list at any time, or if you would like to consider self-funding, please contact Anne McConnell. Should you wish a review appointment with the medical or nursing staff or with the counsellor, the appointments secretary can arrange this for you.
You will receive notification of a patient information evening prior to starting your treatment. This will give you an opportunity to meet some of the staff involved in the whole process and you will be sent details of this meeting, along with detailed instructions about your treatment. A copy of this will be sent to your own general practitioner and you should feel free to talk things over with him/her. The procedures and drugs involved may change from time to time and a more detailed summary will be sent to you just before you start treatment.
HUMAN FERTILISATION AND EMBRYOLOGY AUTHORITY (HFEA)
The HFEA sets standards for Assisted Conception Units. They inspect them annually and license only those Units which meet their standards. We are a licensed Centre, which means; We are legally required to inform the HFEA of all couples undergoing assisted reproduction techniques. If you become pregnant as a result of treatment, we are obliged to notify the Authority of the pregnancy and of its outcome. It is important, therefore, that if you are successful in achieving a pregnancy, you let Anne know details of the outcome. Any child born as a result of IVF, or treatment using donor eggs or donor sperm, has a right to seek information about its origin if they wish, once they reach the age of 18 (or 16 years of age in Scotland if planning to marry). Any child conceived by these techniques may be able to obtain non-identifiable information about the donor. The HFEA make a charge for each treatment cycle and this is included in the cost of your treatment. Following the Human Fertilisation and Embryology Authority (Disclosure of Information Act) 1992, we may legally disclose information about your treatment with your consent to:
i. Any person named by you.
ii. Your GP or anyone involved in providing you with medical, surgical or obstetric services for whom it is important to know about your treatment.
iii. Any person who needs to know about your treatment for purposes of medical or financial audit.
WELFARE OF THE CHILD
The Human Fertilisation and Embryology Act of 1990 requires that the welfare of the child (or any existing children) must be taken into account before treatment can commence at a licensed centre. This includes the welfare of any child born as a result of the treatment (including the need of that child for supportive parenting) and of any other existing child who may be affected by the birth.
Many factors need to be taken into consideration in this assessment, including who would be legally responsible for any child born as a result of treatment, and who it is intended will be bringing up the child.
People seeking treatment are entitled to a fair and unprejudiced assessment of their situation and needs. This is conducted with skill and sensitivity appropriate to the delicacy of the case and the wishes of those involved. The HFE Act does not exclude any category of woman from being considered for treatment. However, in situations where the child will have no legal father the clinic will pay particular attention to the prospective mother’s ability to meet the child’s needs throughout childhood. Where appropriate, the clinic will consider whether there is anyone else within the prospective mother’s family and social circle willing and able to share the responsibility for meeting those needs, and for bringing up, maintaining and caring for the child.
The assessment will involve the centre having a detailed medical and social history covering:
Commitment to having and bringing up a child/children
The ability to provide a stable and supportive environment for any child produced as a result of treatment
Medical histories and medical histories of the families
Health and consequent future ability to look after or provide for a child’s needs.
Ages and likely future ability to look after or provide for a child’s needs.
The ability to meet the needs of any child or children who may be born, including the risk of inherited disorders or transmissible diseases, problems during pregnancy and of neglect or abuse.
The effect of a new baby or babies upon any existing child of the family.
In addition, where treatment involves the use of donated gametes, the following will be taken into account:
A child’s potential need to know about their origins and whether or not the prospective parents are prepared for the questions which may arise while the child is growing up.
The possible attitudes of other members of the family towards the child, and towards their status as a family.
The implications for the welfare of the child if the donor is personally known within the child’s family and social circle.
Any possibility known to the centre of a dispute about the legal fatherhood of the child.
The centre is also required to satisfy itself that the GP of each prospective parent knows of no reason why either might not be suitable for the treatment to be offered. GPs will be asked to provide factual information, medical or otherwise that might have implications for the health or welfare of any resulting child. Written consent will be sought about these issues and prior reading of the letter/questionnaire that will be sent to the GPs. However, failure to give consent will be a factor that may be taken into account in considering whether or not to offer treatment.
If any of these enquiries give cause for concern, the centre will make further enquiries of any relevant individual, authority of agency as it can. Again, consent will be sought before any contact with these bodies is taken. However, failure to give consent will be a factor that may be taken into account in considering whether or not to offer treatment.
The clinician responsible for administering the fertility treatment is responsible for making the final decision about whether or not treatment will be offered. Treatment may be refused on clinical grounds or, if the centre believes that it would not be in the interests of any resulting child, or any child already existing, to provide treatment, or is unable to obtain sufficient information or advice to reach a proper conclusion.
If treatment is refused for any reason, the centre should explain the reasons for this and the factors, if any, which may persuade the centre to reverse its decision. It should also explain the options that remain open and where counselling can be obtained.
Mrs Anne Chien is an independent counsellor. If you would like an appointment to see her, please contact the secretaries on 01382 496475 to arrange this.
If you feel that there is any area for complaint regarding your treatment, there are various ways to deal with this;
1. Contact Anne McConnell at the Assisted Conception Unit.
2. Contact the consultant in charge of your care.
3. The Trust also has its own complaints procedure which you may wish to use. The normal process would be for patients to write to the Chief Executive of the Trust; however, any correspondence may be read by other members of his staff or those working in the Patient Liaison Service, therefore you must bear in mind that, although the normal rules of confidentiality would apply, the special protection offered by the Human Fertilisation and Embryology Act for patients undergoing assisted conception treatment would not be followed. You may therefore wish to address any letters of complaint to either of the following, c/o the Assisted Conception Unit, Ward 35;
Alison Moss, Patient Liaison Manager
Ms L McLay, Chief Executive
The above are both named on our licence held by the HFEA