Infertility is heartbreaking. It seems that it should be the simplest thing in the world, there are babies everywhere, but even if its secondary infertility and you already have one child, it is still very upsetting when family plans don’t happen. However, the realisation that tests are needed can be daunting, worry that something might… or might not be found as the cause.
Infertility Package £190
Frequently cycles are lost waiting for the right point in a woman’s cycle or for test results to come through that come too late and the crucial point in the cycle is missed, so extending any treatment and causing more frustration and upset.
Mr Penman offers an Infertility Package that will not waste any months in waiting for the right point in your menstrual cycle for the next phase or for test results. From the start of the initial consultation to the outcome of the various tests is a maximum of 3 months. Whether your menstrual cycle is erratic or regular, Mr Penman has a detailed package of tests that follow an established sequence of events to find out likely causes for your infertility.
– Initial Consultation
– Planning of Investigations and Treatment
– Prescriptions for medications required throughout treatment. ( It does not include the medications, you will need to take the prescription to the pharmacy and pay the appropriate fee.)
One consultation is all that is required to start the ball rolling, following this, Mr Penman communicates by email following the various tests to advise on the next step so no time is wasted in moving forward to the next test and hopefully to achieving the pregnancy you so desire.
Example Case 1
Mrs Z is a 33 year old woman with one child. She has been trying to get pregnant for 9 months but without success. Her periods are erratic and she menstruates anything from 6 weeks to 9 weeks meaning that she never knows when she is ovulating, or indeed if she is at all. She needs to have a day 21 progesterone estimation to ascertain whether is in fact ovulating. But to do this would usually mean waiting for the next period whenever that might be, however Mr Penman can prescribe Norethisterone. First a pregnancy test is performed just to ensure that she is not already pregnant, then Norethisterone can be taken for 10 days, this will bring on a period a couple of days after finishing the course. So this is day 1 and following this a day 21 progesterone estimation can be taken.
Example Case 2
Mrs B is a 27 year old woman without children. She has been trying for a pregnancy for 5 years. She has regular periods. Mrs B will go straight to a day 21 progesterone estimation.
Both women will then follow the same pathway.
- The husband or partner will have a semen analysis so they can be ruled out further investigations. They can have this performed at the Spire Alexandra Hospital (£79.50)or arrange this with their GP and have the result forwarded onto Mr Penman. If the results are low, Mr Penman will refer your husband/partner to a urologist for further investigations and treatment.
- When the Day 21 progesterone blood is taken, the woman will then send an emai to Mr Penman letting him know that the blood is taken so he can watch out for the result. When the result is through he will email back with the next step.
a) Ovulation has occurred – move straight to Hysteosalpingogram or HSG OR
b) Ovulation has not occurred – Mr Penman will recommend commencing Clomiphene and will recommend the appropriate dose (Clomiphene will be on the prescription he has already given you at your consultation) which will be taken from day 2-6 of your cycle.
3. A further day 21 Progesterone estimation will be planned for those following the Clomiphene route to check for ovulation in the Clomiphene treatment cycle. If ovulation has occurred, the HSG is then carried out.
If ovulation has not occurred, the Clomiphene dose will be increased. Day 21 progesterone repeated.
4. Following the HSG, if nothing abnormal is found, Mr Penman will suggest continuing to try for a pregnancy for a further 4-5 cycles and should a pregnancy not occur, a further consultation is recommended to discuss the various options.
5. If an abnormality is found, Mr Penman will discuss the various options.
6. If ovulation is still not happening following the higher dose of Clomiphene, Mr Penman will offer recommendations for further treatment
Have a look at this handy drawing of the Infertility Pathway
A hysteosalpingogram is a test performed by Mr Penman to check tubal latency. This is done in the outpatient department where dye is blown through the fallopian tubes whilst under ultrasound. Mr Penman observes the dye to check that both tubes are inflated and that the dye passes completely through the fallopian tubes, showing that they are patent and capable of transporting sperm through to fertilise the oncoming egg. This is performed without anaesthetic.
If for some reason the hysteosalpingogram is not possible to perform or there are other issues where a laparoscopy is required, Mr Penman can carry out a Laparoscopy and Dye, where the same process occurs but with the observation through the laparoscope. This costs £2461.
Causes for Infertility
Through the various tests performed through the infertility package, certain causes for the infertility can be detected. One such cause for infertility is Polycystic Ovary Disease or PCOD. It may be that Mr Penman suggests surgery to treat Polycystic Ovary Disease using Laparoscopy and ovarian drilling (ovarian capsular cautery). This can be performed using private medical insurance or by self funding – £3488 Package Price.