Female Fertility
“I would recommend that someone comes along for a fertility consultation if they've been trying to fall pregnant for more than six months and they're over the age of 35 or more than 12 months and they're under the age of 35.”
— Dr Myvanwy McIlveen
Let's Explore
Tubal Flushing (Hysterosalpingogram/HSG)
How long have you been performing tubal flushes?
The doctors at Newcastle Fertility Specialists have been performing their own HSGs for over 20 years. Whilst most gynaecologists will refer you to a radiologist, we do the test ourselves, on our own patients, offering a level of personalised service and skill unique to our practice.
What does the tubal flush test involve?
A speculum, is inserted into the vagina and then a small catheter (tube) placed into the cervix, which is the neck of the uterus (womb). We then inject x-ray contrast from a syringe. Usually, only 5-10ml of liquid is required. As the contrast fills the uterus, it passes into the fallopian tubes, then out the end of the tubes around the ovaries. X-rays are taken by our female radiographer, giving us an outline of your uterus and tubes.
What is a tubal flush?
A tubal flush is a way of checking that the fallopian tubes are open (no blockages). It also has the added benefit of improving pregnancy rates. About 30-40% of younger women who have an HSG will fall pregnant within 6-12 months and not require additional treatment. It’s also far less risky than a laparoscopy.
Are there any risks involved?
Some people experience cramps (period-like pain) that are self-limiting but occasionally intense. Sometimes, people feel faint during or after the procedure. Rarely, infection can be introduced into the pelvis. And for some people, an HSG cannot be performed due to technical difficulties.
What are the benefits of having a laparoscopy instead?
If we suspect you have endometriosis or adhesions we sometimes prefer to do a laparoscopy in order to treat any pathology present. Some people cannot tolerate a HSG and would prefer a laparoscopy, which is done under a general anaesthetic. We’ll discuss the pros and cons of each approach with you based on your personal situation.
Ovulation Irregularities
In cases where ovulation irregularities are evident, or ovulation is infrequent or absent, fertility may be adversely affected. However, this does not signify that pregnancy is an impossibility. In such instances, medical intervention and management may be required, but an initial fertility assessment is recommended.
What if my ovulation is irregular? Irregular Ovulation:
Inconsistent ovulation or ovulation occurring at irregular intervals may be attributed to hormonal imbalances or underlying health conditions.
What if I’m ovulating less? Luteal Phase Deficiency:
A shortened luteal phase, the second half of the menstrual cycle after ovulation, can pose challenges to the successful implantation of a fertilised egg in the uterus.
What if I’m not ovulating at all? Anovulation:
Complete absence of ovulation can result from hormonal imbalances, stress, excessive exercise, Polycystic Ovary Syndrome (PCOS), or other medical conditions.
What is the AMH Test?
When you’re born, you have a certain lifetime supply of eggs. The older you get, the more this supply slowly decreases in quality and quantity. The AMH blood test measures how many eggs you have remaining & what age menopause will be.
Whatever your AMH test score, there’s no guarantee you’ll fall pregnant. It’s only a gauge for your ovarian reserve (quantity), and it can’t tell us anything about your egg quality. Egg quality decreases with age, and sadly we can’t test or measure egg quality.
Endometriosis
What is endometriosis?
Endometriosis is a chronic medical condition characterised by the presence of tissue akin to the uterine lining growing outside the confines of the uterus. This condition often causes pain, premenstrual spotting and the potential development of blocked fallopian tubes.
Is IVF recommended for endometriosis?
Endometriosis can lead to pelvic scarring, tubal dysfunction and diminished egg reserve, thereby reducing natural fertility. IVF offers an effective solution by achieving fertilisation outside the body away from the affected pelvis and then transferring the resulting embryos into the uterus, thereby therefore bypassing the endometriosis. We often recommend IVF if surgery was not successful or it is your preference rather than surgery.
Blocked Fallopian Tubes
It’s possible for blocked fallopian tubes to occur even in a fertile woman when obstructions impede one or both of the tubes connecting the ovaries to the uterus. These tubes play a pivotal role in transporting eggs from the ovaries to the uterus and providing a conduit for sperm to fertilise the egg.
Several potential causes contribute to blocked tubes, including:
Pelvic Inflammatory Disease (PID):
Infections, primarily stemming from sexually transmitted infections (STIs), can incite inflammation and scarring within the fallopian tubes.
Endometriosis:
This condition involves the growth of tissue similar to the uterine lining outside the uterus, potentially resulting in adhesions and tubal blockages.
Previous Surgical Interventions:
Prior abdominal or pelvic surgeries, such as appendicitis or ectopic pregnancy procedures, can lead to the formation of scar tissue, obstructing the tubes.
Ectopic Pregnancy:
Occurring outside the uterus, often within the fallopian tube, ectopic pregnancies can result in damage and blockage.
How do blocked tubes impact fertility?
Blocked tubes hinder the union of egg and sperm, making natural conception challenging. In cases where fertilisation does occur but the fertilised egg cannot traverse the blocked tube to reach the uterus, ectopic pregnancy may ensue, presenting a serious medical concern.
How do you diagnose and treat blocked tubes?
The diagnosis of blocked fallopian tubes typically involves a comprehensive assessment, including a review of medical history, physical examinations, imaging tests, and minimally invasive procedures such as hysterosalpingography (HSG). In the latter procedure, contrast dye is introduced into the uterus, and X-rays are utilised to visualise the fallopian tubes.
Treatment strategies vary based on the degree of blockage. Mild blockages may be addressed through fertility medications or minimally invasive procedures like laparoscopy to enhance tube function. In cases of severe or irreparable blockages, assisted reproductive technologies such as IVF can bypass the fallopian tubes, thereby increasing the likelihood of pregnancy.
Polycystic Ovary Syndrome (PCOS)
What is PCOS?
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that can impact individuals with ovaries. It can cause a number of symptoms, including irregular menstrual cycles, elevated androgen (male hormone) levels, and the presence of multiple small follicles on the ovaries. The appearance of these follicles gives the syndrome its name BUT most people with PCOS do NOT have cysts on their ovaries- they have lots of follicles that are quite small.
What causes it?
We are not sure of the exact cause; however, PCOS is believed to result from a combination of genetic and environmental factors. Insulin resistance is frequently associated with PCOS, contributing to increased androgen levels and disruptions in the normal menstrual cycle.
What are the common symptoms?
Symptoms of PCOS can vary, but frequently include irregular or infrequent menstruation, or even amenorrhea (absence of periods altogether), rendering it a leading cause of infertility. Acne, facial hair growth, problems losing weight, abnormal vaginal bleeding are all quite common.
How do you diagnose PCOS
Diagnosis is using a combination of symptoms & lab testing. We will measure yourhormone levels on a blood test, including estrogens, androgens, LH, FSH, prolactin, AMH & insulin. Ultrasound imaging is done to visualise the ovaries & do a follicle count.
How do you treat PCOS?
Treatment strategies hinge on what your symptoms are & what your goals are. Lifestyle modification through diet and exercise can help if your BMI is over 25. For people wanting to fall pregnant we often start oral medications like letrozole (Femara) & clomiphene (Clomid). We then do blood tests to check if you are ovulating. If the oral ovulation induction agents are not successful then we can trial hormone injections &/or IVF. Very rarely we may offer laparoscopic ovarian drilling which is a surgical procedure that can correct ovulation issues in women with PCOS.
For weight loss we recommend seeing your GP to discuss options. They may recommend a dietician, exercise physiologist or weight loss medications such as Saxenda, Contrave or Duromine. We do not recommend Ozempic because of its long half-life when you are trying to conceive. Some patients with insulin resistance may be started on metformin (Diaformin) which helps lower insulin levels.
Is IVF safe for patients with PCOS?
It definitely can be trickier to do IVF for a person with PCOS if their egg count is very high. We don’t want to get too many eggs all at once & make you feel unwell (Ovarian hyperstimulation syndrome). The good news is that with modern IVF stimulation techniques IVF has become much safer & women with PCOS have more opportunities than ever to safely conceive with IVF.
Endometrial PRP Treatment
Endometrial PRP for Recurrent Implantation Failure and Thin Endometrium
Endometrial Platelet Rich Plasma (PRP) is a new adjuvant fertility treatment option for women who have had Recurrent Implantation Failure (RIF) following IVF embryo transfer.
PRP has a four-to-five-fold higher concentration of platelets than normal plasma and is separated from whole blood via centrifugation. PRP has been used widely for several years across a number of medical disciplines to promote healing and tissue regeneration, including in heart disease, for neurological damage, sports injuries, ophthalmology, hair loss and skin therapy.
The aim of Endometrial PRP therapy is to increase endometrial thickness and receptivity which are considered key factors for successful embryonic implantation.
What is the evidence for Endometrial PRP?
Endometrial PRP for women with RIF involves infusing growth-factor-rich platelets directly into the uterus. More than 200 different growth factors and cytokines (protein signalling molecules) are present in PRP and it is believed these may positively influence endometrial embryo acceptance, growth and improve pregnancy outcomes in some women. Some small studies have shown evidence of benefit but the data is not definitive & more studies are needed to be sure of benefit.
What are the potential risks of Endometrial PRP?
Endometrial PRP is considered a low-risk and relatively safe procedure, however, as with any invasive procedure, there is a slight risk of infection. The procedure is performed under sterile conditions to minimise risks; however, it is essential to watch for signs of infection including increased pain, fever or unusual discharge.
Endometrial PRP therapy does not guarantee improved fertility or a successful pregnancy. Its effectiveness can vary between individuals and success may depend on various other factors.
Am I suitable for Endometrial PRP?
Endometrial PRP is not suitable for people with blood or platelet disorders or for people undergoing certain treatments or with specific medical conditions. Your Newcastle Fertility Specialist can assess your suitability & discuss the possible benefits at your appointment. The PRP treatment is conducted through Genea Newcastle.