Fertility counselling for same sex couples

Considering fertility treatment can be difficult for any family, but the road can be even tougher for LGBTQ families.

The good news is, that now, more than ever before, there are more options available for these couples who are ready to grow their families.  Seeking fertility treatment in private clinics is becoming increasingly common for same sex couples and there are a myriad of therapies, like counselling, that can support you on your journey.

For same sex couples who are looking to have a biological connection to their children there are three options, which are intra-uterine insemination (IUI), in-vitro fertilisation (IVF), or surrogacy. Typically, IUI is the main treatment used for female couples looking to start their family; and IVF can also be used if the couples is experiencing fertility issues.  For male couples, surrogacy is the main treatment used and within that treatment they can chose between gestational or traditional surrogacy.

However, there are many emotional implications associated with these treatments and counselling can be useful to explore the challenges that same sex couples might face as they are growing their family.  In the beginning of the journey we can discuss if donor conception the right choice for you, the implications of using donor gametes and the intricacies of what it means for a same sex couple to start a family in a world where bias and prejudice still exists.  We can talk about how your friends and family might react, and how this might affect those relationships.  We can discuss what all this means for you as a couple, how it might affect your future children and how, as a family, you can prepare for this.    As your counsellor I want to ensure you have the right support throughout your journey because the most important aspect of fertility counselling is that you feel supported throughout the entire process.  I endeavour to create a warm, safe, affirming and non-judgemental space to discuss anything that may for you during your fertility journey.

Article by BICA accredited counsellor, Jamie Forster, one of our Patient Support Partners.

Fertility counselling for single parents

Today, more than ever, it seems like our priorities are shifting and as we find our new individual autonomy in this modern world, many people are making the choice to delay parenthood.

We are travelling more, building careers, and really engaging the right to wait to have children until the time is right for each individual.  This shift in perspective means that there is less pressure to get married and have children as soon as possible, and it means people are waiting longer.  However, this means that sometimes the desire to have children comes before the relationship, or sometimes the relationship fails before desire.  Either way if you are single and considering starting your own family, there are many things to think about before you embark on this journey and counselling is a fantastic opportunity to discuss the key issues that arise from pursuing single parenthood.

There are many options for single women to have children, including egg freezing, home insemination, intrauterine insemination (IUI), in-vitro fertilization (IVF), surrogacy.  For men, the options for having biological children are limited to surrogacy, but in both instances, there are many factors to consider before beginning treatment.

Counselling will give you the opportunity to discuss the different treatment options and look at how this might affect your current relationships with friends and family.  We can explore what this alternative family arrangement means to you and how well you are equipped to deal with the judgments and biases that still exist in today’s society.  We will talk about the implications of using donor gametes and what that means in terms of legal parentage, donor rights and the rights of your future child.  However, the most important aspect of fertility counselling is that you have a warm, empathic and non-judgmental place where you can explore the emotions, issues, or questions that will arise as a part of your journey to become a parent.

Article by BICA accredited counsellor, Jamie Forster, one of our Patient Support Partners.

Sperm Freezing

In men with azoospermia (complete absence of sperm in the semen), surgical sperm extraction from the testis or epididymis might be their only option. Recent research has also shown that in men with sperm present in their semen, but of very low concentration and quality, surgically extracted sperm directly from the testicle is often completely normal.

The handling of surgically retrieved sperm then becomes a major logistical challenge. If a couple wanted to use fresh eggs and fresh sperm on the same day for IVF or ICSI, both partners would need to undergo surgery simultaneously. If this single cycle fails, there would be no back-up.

Sperm Freezing” addresses this dilemma and retains precious sperm in storage. If a cycle of IVF or ICSI fails to create embryos, or embryo transfer fails to result in a pregnancy, further cycles of assisted fertility treatment can be attempted later.

Cryopreservation technology aims to preserve the normal function of cells at very low temperatures, where normal cellular function does not take place.

Cryopreservation of surgically retrieved sperm (in comparison to healthy ejaculated semen) is more cumbersome and difficult because of

  1. low number of retrieved sperm
  2. lack of sperm motility
  3. contaminated with high proportion of cellular debris and red blood cells.

However, it is perfectly feasible in the hands of trained embryologists. Cryopreservation of testicular spermatozoa on the day of biopsy is an upcoming strategy, since many studies have shown that there are no significant differences in terms of fertilization and embryo developmental rates compared with those of fresh testicular sperm.

At the Reproductive Health Group, this technology is part of our standard services. If you would like to talk to us about sperm freezing, please call us on 01925 202180 or contact us here.

The latest developments in Pre-Implantation Genetic Testing

Pre-Implantation Genetic Testing (PGT) isn’t a new science, it’s been available to fertility specialists for some time now, but last year a great step forward was made by the laboratory that Reproductive Health Group work with that enables couples to make informed decisions about their journey to parenthood.

‘In the very simplest terms, PGT gives information about embryos’ genetic health to help embryologists select the best embryo for transfer and improve the chance of achieving a successful pregnancy. Once a known healthy embryo has implanted there is a higher likelihood of the pregnancy progressing to full term.

‘We use PGTai and recommend it for our older ladies and those who have had previous unsuccessful fertility treatment. This is because as we age, it has an effect on the genetic make-up of any embryos we make, either naturally or after IVF. When an embryo is created it should have 46 chromosomes; this is known as a ‘euploid’ embryo. If it hasn’t got 46 chromosomes then it is known as ‘aneuploid’ and is genetically abnormal. In older women, we see an increase in the number of Aneuploid embryos being created. When this happens, there is a vastly increased likelihood that the body will reject the embryo, resulting in no pregnancy or a miscarriage.

‘In PGTai, we take an embryo when it is at the blastocyst stage, just five days into its development. At this point, it has a central mass of differentiated cells that would go on to form the baby, and a surrounding cell mass that would go on to form the placenta – it is from here that we extract three to five cells for testing and send them to our chosen partners who are at the forefront of this type of technology. The ‘ai’ bit refers to the artificial intelligence element of the tests, which produce quite extraordinarily detailed results. The AI is based on the test results of 1,000 embryos that went on to create healthy babies and the whole testing platform has been validated on 10,000 embryo tests and 5 million data points.

‘Until fairly recently, the results we would receive back from testing would tell us if the embryo was Euploid or Aneuploid. We would have many patients for whom all the embryos we tested were recorded as Aneuploid, meaning that we couldn’t proceed with treatment with those embryos. Now, the AI is so smart, it can in effect give us a sliding scale of ‘normality’.

‘Today, we have four bands. euploid; low level mosaic – meaning that the embryo has 20-40% of its cells showing as ‘abnormal’; high level mosaic – with 40-80% of the cells as abnormal; and finally, aneuploid.

So that’s the science, but what does this mean for patients?

‘As an example, we might have a patient with two day-5 blastocysts which both have cells sent for PGTai. The results for one blastocyst comes back as aneuploid (abnormal and cannot be used for treatment) and the other embryo comes back as a low level mosaic, which can be used for treatment: implanting a low level mosaic embryo in the womb can result in a positive pregnancy test and recent evidence has shown that these pregnancies give a 50% chance of delivery of a live baby. Previously we would have rejected both of these embryos. A high level mosaic rating offers a 30% chance of a successful pregnancy.

‘It’s really about giving couples more opportunity to decide how they want to proceed. Everybody who has embryos sent for genetic testing from RHG has the opportunity to participate in genetic counselling, where we can help them understand the science and what that means for them, personally.

‘For me, it’s very exciting. I honestly believe that this form of testing will become available for all women and that there will come a time when it will become routine for embryos to be tested before they are used for treatment. This is ground breaking technology that has improved the accuracy with interpreting the results from PGT and removed any subjectivity. This is a very exciting area of reproductive science and it’s wonderful to be at the forefront of it in the UK.’

This article was originally published on the Living Edge website here.

Fertility Coach

If you are going through infertility and your emotions are all over the place, you are not alone. In fact, this journey is a roller coaster of emotions. In a recent study, patients going through fertility challenges have reported that 90% felt depressed, 42% felt suicidal, 50% reported it was the most upsetting experience of their lives and 4 in 10 experienced PTSD after miscarriage.

These feelings may be triggered for different reasons:

  • not being able to grow your family when you want, and the way you had planned
  • stigma and social pressure
  • feelings of isolation
  • financial pressure
  • need to make/delay decisions around professional career
  • coping with recurrent loss
  • and the emotional stress of making important decisions as a couple, who may at certain times, feel differently about motivation to treatment, length and type of treatment, have different coping strategies, or different opinions on what to do when treatment fails.

The bottom line is that regardless of how complex a physical problem may be impacting on your fertility, it is actually the emotional distress that will probably make you quit treatment.

One way of getting support is through Fertility Coaching. A fertility coach is someone who guides you in your journey. Often, they have been through it themselves and can relate to the challenges you are going through. Apart from personal experience, a fertility coach also has a particular set of professional skills and competencies to provide the emotional and physical support that people require. This often includes a medical degree (to understand the physical aspects of fertility) and a CBT/NLP coaching qualification (to provide emotional support).

The support provided by a fertility coach may be emotional, covering all the aspects discussed above, and/or physical, helping you with practical aspects of fertility treatment like medication, making changes to your diet, environment etc.

Here’s 8 ways a fertility coach could help you during fertility treatment and make a significant difference in your journey:

  1. Managing anxiety, stress, depression, expectations
  2. Communication and difficult conversations
  3. Making decisions
  4. Strategies for key moments (before/after embryo transfer, two-week wait)
  5. Motivation and commitment to treatment
  6. Improving your health for fertility (nutrition, physical activity, environment, habits)
  7. Setting up goals, action plans
  8. Following up and accountability

At Reproductive Health Group we are aware most people underestimate the emotional distress that may be caused by infertility, so whatever stage you’re in, make sure you are prepared. In our commitment to support you, we are offering a Free Fertility Coaching consultation with the awarded Nurse Consultant and NLP Coach Andreia Trigo. It’s never too late to start your fertility support plan, why not start today? Book your appointment here.

Andreia TrigoAbout Andreia Trigo

Andreia Trigo (RN, BSc, and MSc) is the founder of inFertile Life, multi-awarded nurse consultant, fertility coach, author and TEDx speaker.  Combining her fourteen-year medical experience, CBT, NLP and her own eighteen-year infertility journey, she has developed unique strategies to help people undergoing similar challenges achieve their reproductive goals. The Enhanced Fertility Programme is helping people worldwide and has been awarded Best Innovation in Business 2018 and E-Business of 2018. Check her out at www.infertile-life.com

Sperm DNA Fragmentation Test

Research presented at the 2019 European Association of Urology Congress in Barcelona revealed that the DNA of sperm extracted from the testicles of infertile men might be just as healthy as the sperm found in the ejaculate of fertile men.

The research could have implications for improved treatment of male infertility.

This research supports past understanding of the role DNA fragmentation in sperm plays in male infertility, as well as how lifestyle risks from poor diets to smoking can affect infertility.

The research suggests that looking into yet-to-be-damaged sperm in the testicles could offer a solution to couples working to overcome infertility challenges.

It’s been known for the last few years that men with high DNA fragmentation rates have more difficulty initiating pregnancy as well as experience higher rates of early term pregnancy loss.

DNA damage assays are currently not considered standard of care by European and American fertility specialists, but many find them useful in certain circumstances – when patients have normal semen analyses parameters but recurrent miscarriage, when a man has a varicocele and more data is needed before a decision can be made about removing it, or when patients have had recurrent IVF or ICSI failure.

Couples whose male partner has a high DNA damage rate in his semen may benefit from a minor surgical procedure to extract sperm directly from the testicle, and this may increase that couple’s odds of a viable pregnancy.

At RHG, we are proud to offer both, the diagnostic and therapeutic elements of this new approach – DNA fragmentation testing, as well as surgical sperm extraction.

Source: https://www.healthline.com/health-news/dna-of-sperm-from-infertile-men-as-healthy-as-sperm-from-fertile-men

Varicocele and infertility

35-40% of men undergoing infertility evaluation have a varicocele. Although the damage caused might be multifactorial and the exact mechanism is not fully understood, testicular hyperthermia is probably a significant factor.

Today, treatment has evolved into a variety of techniques. There is a consensus between the European Association of Urology (EAU) and American Society for Reproductive Medicine (ASRM) in the role of varicocele treatment for infertile men with abnormal semen parameters:

  • Varicocele repair was shown to be effective in men with oligospermia, a clinical varicocele and otherwise unexplained infertility.
  • Treat varicoceles in adolescents who have reduced testicular volume and evidence of progressive testicular dysfunction.
  • Treat men with a clinical varicocele, oligo-zoospermia and otherwise unexplained infertility in the couple.

However, The National Institute for Health and Care Excellence (NICE) “recommends that men should not be offered surgery for varicoceles as a form of fertility treatment, because it does not improve pregnancy rates.”

One might wonder: is NICE guidance still up-to-date? What evidence does NICE have that is not available to European and American specialist associations? Or is this another “Procedure of Low Clinical Priority” (PLCP), rationed for NHS availability by a UK government body?

At RHG, we believe that varicocele surgery should be offered to selected men who fall into the above listed categories. In case this fails, and if female reproductive age is a time-limiting factor, we offer Surgical Sperm Retrieval (SSR) during the same procedure, as an “insurance policy”. Sperm can be frozen and used later for Intra-Cystoplasmatic Sperm Injection (ICSI).

Contact us

If you would like to contact us to about treatment of a varicocele or male fertility assessments, please call us on 01925 202 180 or contact us online here.

Surgical Sperm Retrieval at the time of Vasectomy Reversal

England and Wales have the highest divorce rate in the EU with 42% of all marriages failing. 5% of men who had a vasectomy request reversal at a later date. The European Association of Urology (EAU) issued the following strong recommendations:

  • Microsurgical vasectomy reversal is a low-risk and (cost-) effective method of restoring fertility.
  • Surgical Sperm Retrieval (SSR) and ICSI should be reserved for failed vasectomy reversal.

Vasectomy reversal affords up to 90% success rates and natural conception for couples who are not in a hurry.

However, successful pregnancy and life birth rates after vasectomy reversal can be significantly lower for a variety of adverse reasons, even if men had children with the same or other partners:

  • poor ovarian reserve in older women
  • other female-specific factors e.g. endometriosis or pelvic inflammatory disease
  • long obstructive interval between vasectomy and reversal
  • male epididymal and sex gland dysfunction
  • life style (e.g. smoking, obesity, anabolic steroids)

In these scenarios, SSR and IVF or ICSI might be the only realistic alternative. We believe that men with a poorer prognosis of successful vasectomy reversal should be offered surgical sperm retrieval and freezing as an “insurance policy”, at the time of reversal. This avoids delays and second procedures on the same testicle, although it incurs additional expenses for surgery and sperm storage. We are pleased to announce that this service is available at RHG.

Contact us

If you would like to contact us to discuss SSR or Vasectomy Reversal, please call us on 01925 202 180 or contact us online here.

Private Maternity Care

Author: Dr Koon Loong Chan, Consultant Obstetrician and Subspecialist in Fetal and Maternal Medicine

Being pregnant is an exciting time but can also be daunting for mums-to-be, especially if this is your first baby and don’t know what to expect. Antenatal care is dedicated to giving you the support and healthcare you and your baby need while you are pregnant to ensure you have a healthy pregnancy and baby. It will also give you an opportunity to plan your birth and to get any concerns you may have answered by the midwife or obstetrician (doctor specialising in pregnancy care).

Differences between NHS and Private Care

The majority of pregnant women have pregnancy care provided by the NHS and deliver in a NHS hospital. This is perfectly adequate for these women. However, some women chose to have private pregnancy care. This may be a package of pregnancy care catering for the pregnancy, delivery and after delivery or a package of pregnancy care catering for the pregnancy and after delivery but not the delivery itself – this is provided by the NHS hospital you chose to book and deliver at.

There will be women who would be adequately looked after in the NHS but prefer to have private pregnancy care so they have more choice over who takes care of them and prefer the one-to-one care that private pregnancy care offers. Women who are relatively high risk may still chose to have private pregnancy care as this may give them more reassurance to ensure a stress-free and enjoyable pregnancy.

Our Private Maternity Packages

At Reproductive Health Group, we have private obstetricians who are Consultants in Obstetrics and Specialists in Maternal and Fetal Medicine at St Mary’s Hospital, Manchester who offer care for the pregnancy and after delivery but, at present, not delivery. The Consultant package will provide a high level of specialised care which will help you feel reassured throughout your pregnancy. We also offer a Midwifery package for those women that are low risk. Whichever package you chose you will regularly see the same team of specialists for consultations, scans and blood tests. We also offer individual tailored care so that you can chose what tests and scans you prefer during your pregnancy. This tailored care can be discussed at your first visit with the Consultant or the Midwife. We offer a relaxed environment giving time for consultations and visits that are convenient.

Benefits of Private Care

  • Consultant led care
  • Appointments usually seen with a private midwife
  • No waiting lists – you will be seen promptly
  • Relaxed and calm environment
  • More time dedicated to you and your baby
  • Clean and safe private hospital
  • Free parking and refreshments
  • Professional, caring and friendly staff

If you would like to talk to us about our maternity care packages, please call us on 01925 202180 or contact us via our website here.

Egg Freezing Cycle Offer

We are delighted to announce that you can save 10% on all Egg Freezing cycles completed before the 31st December 2018. For more details about this limited time offer, please call us on 01925 202180, email us at info@reproductivehealthgroup.co.uk or contact us here.