What else do I need to know?
What might delay my starting treatment?
Please be aware that we are obliged to have a closure period
once every year to ensure essential safety checks and maintenance
of theatres and laboratories can be carried out.
This may include equipment checks, servicing and
environmental checks such as air quality and cleaning.
This closure period takes place in December but this will affect
some treatment requests from November as the need for theatre or
laboratory services may fall within the closure period.
If you have any queries regarding the impact this may have on
your individual treatment cycle please contact the IVF Nurses on
(0161) 276 6209.
Research has shown IVF is more successful when women are within
the ideal weight range for their height. There are also added risks
to a pregnancy when women are overweight. As such we will only
offer NHS-funded treatment to women who have a BMI between 19-30. A
healthy balanced diet for both partners can help increase
success. Women are also advised to take folic acid
supplements daily (0.4mg) when trying to conceive.
Both partners MUST NOT smoke when undergoing NHS-funded IVF
treatment as, aside from the known damage to health this causes,
smoking decreases success rates of IVF. If either of you
smoke, you will be referred back to your GP and can only be
re-referred once you have been smoke-free for 3 months.
NICE guidelines advise not drinking to excess and drinking no
more than 1 or 2 units of alcohol once or twice a week. A unit of
alcohol is about the same as a small glass (125 ml) of wine or a
half-pint of beer or lager. If you are a man, your fertility
is likely to be affected if you drink more than 3 or 4 units of
alcohol a day. Drinking excessive amounts of alcohol can
affect the quality of a man's sperm.
It is also important for women to have an up-to-date smear test
before starting a treatment cycle as you will not be able to have
this done routinely once pregnant.
Smoking and fertility
Alcohol and fertility
Healthy living - preparing for pregnancy
You will be informed at your initial clinic appointment that
Saint Mary's Hospital can only carry out a finite number of
treatment cycles per week and so you cannot be guaranteed treatment
in any given month. Occasionally we will also have to
accommodate minor closures such as over Bank Holidays and Christmas
and so we may not be able to accept your request for treatment at
If it has been more than 3 months since you had your initial
scan and blood tests, we may need to repeat a few of these tests to
make sure no new issues have arisen.
You will receive an information pack along with your clinic
appointment letter and this will hopefully explain how your
treatment will work.
Once you have been accepted for treatment you will have a 45
minute 'teach' appointment with the nurses to be shown how to use
your medications and you will be able to go through any concerns
you may still have at this time. If the nurse feels you would
benefit from another clinic appointment prior to starting
treatment, this will be arranged for you.
Why might our treatment be delayed once we've
If you are going through a 'long' IVF cycle or planning for a
frozen embryo transfer, you may have a late period whilst on a drug
called 'Buserelin'. This could in turn move all the scheduled
appointment dates on by at least one week. Your nurses will aim to
let you know as best as possible when you will need to attend the
Department, but we ask that you would appreciate the need for
flexibility due to the nature of the treatment and its dependence
on your menstrual cycle.
Why might our treatment be cancelled?
Although great care is taken to make sure you are definitely
ready to start treatment, sometimes unforeseen issues arise.
The most common reasons leading to a cancelled cycle include the
risk of ovarian hyper stimulation syndrome (OHSS), poor response,
development of a hydrosalpinx, and presence of fibroids, cysts or
The risk of OHSS is around 6% and certain groups of women are at
higher risk of developing this, such as young women or those who
have polycystic ovary syndrome (PCOS).
Symptoms include bloating, shortness of breath, chest pain,
nausea and/or vomiting and trouble passing urine. If you think you
are developing these symptoms you must ring The Department
immediately on (0161) 901
5225, or you can
call the Emergency Gynaecology Unit (EGU) on (0161) 276
6204 out of
The clinicians will have taken extra measures to help those at
increased risk such as planning extra monitoring blood tests and a
lower start dose of stimulation. Even when early OHSS
symptoms arise, measures can be taken to salvage the treatment, by
'coasting' stimulation, or by planning to freeze all suitable
embryos after egg collection as symptoms can worsen with pregnancy.
However OHSS symptoms can arise suddenly or unexpectedly and in
such cases it can be safer to cancel a treatment cycle. In 1%
of cases women may need to be hospitalised for treatment of the
Despite having your stimulation dose tailored to you with your
AMH result, sometimes women unexpectedly respond poorly to the
treatment, or may respond worse than expected. Often you would be
warned of this if your AMH or antral follicle count was low at the
time of your initial investigations, or if a previous cycle had
also had a suboptimal outcome.
The nurses will explain your response to treatment to you after
each scan or blood test appointment and if less than 3 follicles
have grown, the consultant would decide to cancel your cycle.
Sometimes, if circumstances allow, your IVF cycle may be converted
to an IUI cycle whereby you are inseminated with your partner's or
your donor's sperm. If this option is chosen for you, the nurse
will fully explain what this entails.
If treatment is cancelled, the cycle cannot be restarted. It
will count as one of your NHS-funded cycles.
Ovarian cysts can develop either before or during a treatment
cycle and often are not harmful.
If simple cysts are seen on either ovary at the baseline scan
before treatment, these can affect your oestradiol hormone levels
and they will often be raised. For treatment to start we need your
oestradiol to be <200. If the hormone level is too high we would
ask you to re-request treatment on the first day of your next
period and we would test again. Simple cysts often disappear
of their own accord.
More complex or large cysts may need to be removed prior to
starting treatment and we would explain how this is done should it
be needed. Each case is individual.
Fibroids are not harmful and you will often not have any
symptoms. However if a fibroid is seen on your scan, this may need
treating before continuing on to embryo transfer, especially if the
fibroid is 'submucosal' (i.e. in the layer of tissue lining your
womb) or is indenting the lining of your womb as this could affect
implantation of your embryos. If a fibroid becomes apparent
during your treatment, the doctor may speak to you about having
further investigations. This may involve having any embryos that
are suitable resulting from your treatment frozen after egg
collection and having the embryo(s) replaced at a later date once
you have had the necessary investigations. The procedure you may
need is called a laparoscopy. This would confirm the diagnosis and
possibly treat the fibroid at the same time. The doctor will
discuss the options with you if the situation arises.
Fluid can collect inside the fallopian tubes and this is called
a 'hydrosalpinx'. Previous scans may not have shown any signs of a
hydrosalpinx yet it can quickly develop during treatment and can be
as a response to the hormones. If fluid is also noted in the cavity
of your womb this could be problematic for your embryos as the
fluid itself can be toxic to the embryos, or it may physically
prevent implantation. There are two options for treating a
hydrosalpinx and these are, either to have any embryos that are
suitable resulting from your treatment frozen and then have surgery
on your tube(s). The embryo(s) would then be replaced at a
later date. Another option may be for the doctor to attempt to
drain the fluid from your tube at the time of egg collection. The
doctor will discuss the options with you if the situation
A polyp is a soft outgrowth from the 'endometrium' or lining of
your womb. If during an ultrasound scan a polyp is detected,
depending on its size the doctor may discuss with you the need to
have this removed as it could lead to difficulty in becoming
pregnant. If a polyp becomes apparent during your treatment, the
doctor may speak to you about having any embryos that may be
suitable frozen after egg collection and having your embryo(s)
replaced at a later date once you have had the necessary surgery.
The procedure you may need is called a hysteroscopy. This would
confirm the diagnosis and possibly treat the polyp at the same
time. The doctor will discuss the options with you if the situation