Frequently Asked Questions
MFS
- Is MFS part of a hospital?
- How long has MFS been established?
- Will a patient have to go to any hospital as part of their treatment at MFS?
- Will a patient always see the same nurse or doctor?
- Are appointments available at MFS before or after normal office hours?
- How long is the waiting list for treatment at MFS?
Success rates
Cost of treatment
Investigations, treatments and risks
- What services does MFS offer?
- How long does treatment take?
- How many appointments are required?
- What tests are required before treatment starts?
- Can MFS use the results of tests a patient has previously had to avoid having to repeat them?
- Do husbands or partners have to attend every appointment?
- What counselling services does MFS offer?
- What are the risks of fertility treatment?
- What if a patient needs to speak to someone urgently about their treatment outside of clinic hours?
- How many embryos can a woman have transferred at MFS?
- Who are the egg, sperm and embryo donors at MFS?
- What should a patient do if she gets pregnant?
- What should a patient do if she doesn’t get pregnant?
MFS
Is MFS part of a hospital?
MFS is registered by the Healthcare Commission as an independent hospital, providing a full-range of fertility investigations and treatments from its clinic in Aldridge, near Walsall. All staff work exclusively for MFS and are experts in their fields.
How long has MFS been established?
MFS was established in 1987 and moved to its current location in Aldridge in 1993.
Will a patient have to go to any other hospital as part of their treatment at MFS?
Not usually. All services and care for both male and female patients can normally be provided at MFS.
Will a patient always see the same nurse or doctor?
MFS is a nurse-led practice and so many patients see the same fertility nurse specialists or clinical midwives for most of their appointments, but rarely a single individual nurse for all appointments. All MFS nurses are trained in ultrasound scanning, many of them perform IUI insemination and embryo transfers and three MFS nurses also do egg collections. This means that a nurse with whom the patient is familiar will usually participate in almost all stages of treatment, rather than simply relay information to patient.
New patients usually meet one of the MFS doctors at their initial consultation and possibly at other important stages of their treatment.
Are appointments available at MFS before or after normal office hours?
Appointments are available from 7.30am to 6.30pm Monday to Thursday and to 6.00pm on a Friday for patient convenience, although the ‘before and after office hours’ appointments are filled quickly. Morning appointments are available at the weekend for time-dependent scans and emergencies, but not for initial consultations, treatment assessments or follow-up appointments. MFS is also open on most bank holidays.
How long is the waiting list for treatment at MFS?
- self-funded patients
First visits are usually available within four weeks and there is no wait for subsequent treatment.
- NHS-funded patients
MFS currently provides NHS funded treatment for 10 Primary Care Trusts (PCTs). Each PCT has its own criteria for funding and waiting times can vary, from immediately to a few years. For further information email Linda Tanner, MFS’s NHS contracts manager, or phone her on 01922 455911, 10.00am-3.30pm, Wednesday to Friday.
Success rates
What is the live birth rate for treatments at MFS?
Live Birth Rate (LBR) statistics in a clinic’s success rates give an accurate indication of the chances of having a baby after fertility treatment at any licensed clinic. MFS uses the method preferred by the HFEA to calculate the LBR, ie the number of live birth events (twins and triplets count as one live birth event) divided by the number of:
- treatment cycles started
- egg collections
- embryo transfers
Treatment cycles started
The LBR per ‘treatment cycles started’ includes all relevant treatments (fresh stimulated IVF/ICSI using patients’ own eggs) given by MFS. This gives the lowest LBR of the three stages as it includes cycles where patients failed to produce eggs or treatment cycles that were abandoned before eggs were recovered due to the risk of ovarian hyperstimulation syndrome (OHSS).
Egg collections
the LBR per egg collection reflects a number of factors including:
- ovarian stimulation
- the number of eggs recovered
- fertilisation rates
- the quality of the embryology
- the embryo transfer technique
Embryo transfer
The LBR per embryo transfer rate (regardless of the number of embryos replaced) reflects only the quality of the embryology and the embryo transfer technique. The nearer this rate is to the LBR per egg collection, the better.
Cost of treatment
What is the cost of treatment at MFS?
See the current list of charges for treatment costs and use the MFS Cost Calculator© to estimate the total cost of the investigations or treatment being considered.
Is NHS funding available for treatment?
MFS currently provides NHS funded treatment for 10 Primary Care Trusts (PCTs). For further information on criteria for funding email Linda Tanner, MFS’s NHS contracts manager, or phone her on 01922 455911, 10.00am-3.30pm, Wednesday to Friday.
Investigations, treatments and risks
What services does MFS offer?
MFS offers a full range of fertility investigations and treatments.
Investigations include:
- ovarian reserve testing
- fertility investigation package
- recurrent miscarriage testing
- HyCosy tubal patency testing
- sperm analysis
Treatments include:
- IUI
- IVF
- ICSI
- donor sperm, egg and embryo treatments
- egg freezing for cancer patients
- egg freezing for non-medical fertility preservation
- surrogacy
- surgical sperm recovery
Other services and procedures include:
- egg sharing with IVF or ICSI
- sperm freezing
- embryo freezing
- genetic screening
- vasectomy reversal back-up plan
MFS also offers counselling services and acupuncture to help patients during their treatment.
How long does treatment take?
The length of time depends on the type of treatment. As a rule, if a patient is able to proceed immediately, funding is available and no additional tests are needed, from first visit to pregnancy test:
- IUI: eight weeks
-
IVF or ICSI: about three months
How many appointments are required?
The number of appointments depends on the type of treatment the patient is having, but including initial consultation, treatment assessment, follow-up appointments, monitoring scans, and the IUI, IVF or ICSI procedure itself, allow:
- IUI: three to four appointments
-
IVF or ICSI: eight to ten appointments, depending on the progress of treatment
What tests are required before treatment starts?
Both the man and woman will require a treatment assessment before treatment can begin, including:
- blood tests to check for infectious diseases HIV and Hepatitis B and Hepatitis C
- blood tests to measure the woman’s hormone levels - and occasionally the man’s too
- a vaginal ultrasound scan of the woman
-
a sperm sample for analysis from the man
Can MFS use the results of tests a patient has previously had to avoid having to repeat them?
Very occasionally MFS can use the results of tests recently conducted elsewhere, but usually these tests will need to be repeated at MFS and analysed in either in one of the MFS laboratories or in one of the off-site labs that conduct specialist tests for MFS. An MFS nurse or doctor will be able to advise each patient.
Do husbands or partners have to attend every appointment?
Husbands and partners must attend the initial consultation and, if they are providing the sperm for the treatment, should also be available for the treatment assessment, follow-up appointment, egg collectionand insemination. A doctor or nurse will be able to advise exactly which appointments are necessary for husbands or partners. Of course, they are welcome to attend any other appointments too.
What counselling services does MFS offer?
Counselling support is provided by members of the clinical team and also by counsellors trained in infertility counselling. This service is available to all patients before, during and after treatment, for fertility related issues, and is included in the charges.
What are the risks of fertility treatment?
- OHSS
- ectopic pregnancy
- multiple pregnancy
- death
OHSS
The drugs prescribed to help a woman’s ovariesproduce more eggs may cause harm if they work too well. This over-response can develop into ovarian hyperstimulation syndrome (OHSS). Clinical staff at MFS monitor ovarian stimulation very carefully to help prevent OHSS, and so it occurs in only 0.3% of all treatment cycles at MFS. Symptoms of mild OHSS include:
- a swollen stomach or abdomen
- stomach pains
Indications of more severe cases include:
- vomiting
- breathlessness
- feeling faint
- passing dark discoloured urine
OHSS is potentially very serious, so if a patient starts to experience any of these symptoms, she should contact MFS immediately on 01922 455911, even out of clinic hours.
Most cases of OHSS settle with mild pain killers such as paracetamol, drinking more water or dilute juice (but not tea, coffee or alcohol), and gentle exercise. MFS staff will monitor the development of OHSS in any patient over the days before any scheduled embryo transfer. If the risk of OHSS developing is high, MFS clinicians may suggest admission to hospital or that the embryo transfer is postponed and the embryos are stored for a future frozen embryo transfer (FET).
Read a PDF of the MFS leaflet: ‘OHSS’
Ectopic pregnancy
An ectopic pregnancy is one that implants outside the endometrial cavity of the uterus, most commonly in the Fallopian tube, but occasionally an embryo can implant on an ovary or elsewhere in the abdominal cavity. These pregnancies are not viable and may need to be removed urgently, possibly with surgery, as they are a considerable risk to a woman’s health. Symptoms of an ectopic pregnancy include:
- intermittent lower abdominal pain
- abnormal vaginal bleeding
- tenderness on one side of the pelvis
Infertile women have an increased risk of ectopic pregnancies, particularly those with tubal damage, a uterine abnormality, or if an intrauterine contraceptive devicehas been used in the past. In the UK, one in 200 pregnancies implants outside the uterus. In IVF or ICSI treatment, ectopic pregnancies can still occur in 2-4% of treatment cycles.
Read a PDF of MFS leaflet: ‘Ectopic Pregnancies’
Multiple pregnancies and births
Multiple pregnancies and births (twins, triplets or more) are the single biggest risk to mothers and babies during fertility treatment and they are six times at risk of complications compared to a singleton pregnancy, including:
- miscarriage, hypertension (high blood pressure), anaemia (iron deficiency), haemorrhage (bleeding), early labour and delivery with forceps or caesarean section
- death of the mother - although this risk is very small, it is doubled for women expecting twins, compared to women who are pregnant with a singleton
- up to 25% of multiple pregnancies are complicated by pregnancy-induced high blood pressure and the incidence of diabetes during pregnancy is two to three times more than in singleton pregnancies
- the risk of pre-eclampsia (high blood pressure with subsequent risks of kidney and heart problems)
In addition, a multiple pregnancy increases risks to the babies of:
- premature birth
- illness
- disability
- death
Like all licensed clinics, MFS adheres to the HFEA code on embryo transfers, which makes a distinction based on age and states that in a single treatment cycle, a maximum of:
- two embryos can be transferred to a woman of less than 40 years of age, with no exceptions
- three embryos may be transferred to a woman aged 40 and over if she is using her own eggs
In addition, MFS also adheres to the elective single embryo transfer (eSET) policy implemented by all fertility clinics in the West Midlands in January 2009, which may affect the number of embryos transferred to a woman who is aged 37 or younger.
Death
Since 1978 more than 120,000 (source: HFEA) women have received fertility treatment in the UK and four deaths have been directly attributable to OHSS during this time. Fortunately, nowadays, pregnancy and childbirth are very safe in the UK but, OHSS, an ectopic pregnancy, a multiple pregnancy or multiple birthall carry a very small risk of death to the pregnant woman. If an MFS patient thinks she is has the symptoms of:
- OHSS, she should call MFS on 01922 455911any time of the day or night
- an ectopic pregnancy can usually be identified at the first pregnancy scan which is carried out two to three weeks following a positive pregnancy test. If a patient has unusual bleeding or pain after a positive test, but before her first scan she should call MFS or go to the A&E of her local hospital
A patient should ensure she clearly understands the risks of a multiple pregnancy and a multiple birth before consenting to the transfer of two or more embryos, if this option is available to her.
What if a patient needs to speak to someone urgently about their treatment outside of clinic hours?
If a patient feels unwell as a result of their on-going treatment or if they have a question about their treatment that needs an immediate answer, they should call 01922 455911 at any time, any day of the year. Out of office hours a message will give the patient a mobile number of a senior member of the MFS team who will deal with any concerns. Please note that these calls will be taken outside of the office and so patient notes will not be available to refer to, and the diary will not be available to book appointments. Calls are taken via a mobile phone and so may be disturbed by background noise, although every effort is made to keep this to a minimum.
How many embryos can a woman have transferred at MFS?
To reduce the risk of multiple births, MFS adheres to the HFEA code on embryo transfers which was implemented in 2001 to achieve a balance between reducing multiple births and the need to maximise a woman’s chance of having a healthy baby. The Code makes a distinction based on age and states that in a single treatment cycle, a maximum of:
- two embryos can be transferred to a woman of less than 40 years of age, with no exceptions
- three embryos may be transferred to a woman aged 40 and over if she is using her own eggs
In IVF or ICSI with a two embryo transfer, the chance of twins is currently 25%. In IUI, with a two - three follicle response, there is a 10% risk of twins.
In addition, MFS also adheres to the elective single embryo transfer (eSET) policy implemented by all fertility clinics in the West Midlands in January 2009 to reduce the number of multiple IVF pregnancies to 10% by 2012. To achieve this, some patients will be offered only a single embryo transfer if:
- she is less than 37 years old, AND
- she is undergoing her first IVF or ICSI treatment, AND
- she has at least one top grade embryo (this is assessed on the day of transfer by an MFS embryologist)
OR
- she has a history of multiple pregnancy (independent of her age) or a multiple pregnancy creates particular risks to the woman
Other factors may also be taken into account and the risks will be discussed with patient by MFS clinical and/or scientific staff.
- Visit www.oneatatime.org.uk
Who are the egg, sperm and embryo donors at MFS?
Women who donate eggs and embryos are non-smokers, aged 18 to 35, with a normal BMI and with no personal or family history of inherited illnesses or abnormalities. They may donate their eggs altruistically or as part of an egg share scheme in exchange for reduced costs of their treatment. Couples who donate embryoshave usually had successful fertility treatment and want others to benefit from the generous gift of their additional embryos. People who donate their eggs or embryos receive no payment from either MFS or the recipient.
Sperm donorsare aged 18 to 45. They are screened for infectious diseases HIV and Hepatitis B and Hepatitis C, as well as for sexually transmitted diseases and genetic abnormalities. A sperm sample is checked for quality, frozen, quarantined for a minimum of 181 days and then thawed to check it can survive the freeze/thaw process. Sperm donors are screened again for infectious diseases after this quarantine period. Only if the sperm is suitable and the results of all the tests are satisfactory is the donor’s sperm used in fertility treatment. MFS uses samples from local donors and also those obtained from elsewhere in the UK and abroad.
What should a patient do if she gets pregnant?
A woman will know if she is pregnant two weeks after her IUI insemination, or ten to 14 days her IVF or ICSI embryo transfer. She should contact MFS as soon as she knows the result of her pregnancy test - not only are the staff excited to know if the treatment has been successful, but MFS also has a legal duty to inform the HFEA of the outcome. She may also need to continue taking hormones prescribed by MFS and so should check with an MFS nurse or doctor before discontinuing these.
She will have a pregnancy scan two weeks after her positive pregnancy test, when she classed as six weeks pregnant. At this very early stage of development, the MFS ultrasound scan should show a gestational sac containing the developing ffetus with a beating heart. This scan is important to ensure that the pregnancy is developing normally within the uterus.
After this early scan, the woman can visit her GP and begin antenatal care like any other pregnancy. Of course, she is always welcome to contact MFS during her pregnancy for advice and MFS staff will look forward to the news on the birth, as again, the clinic must advise the HFEA on the outcome of the pregnancy.
What should a patient do if she doesn’t get pregnant?
If a patient has a negative result for her pregnancy test, she should contact MFS to advise the clinic of the treatment outcome. Staff will be available to offer support and to give best advice at this difficult time and MFS also has a legal duty to inform the HFEA of the outcome.
As with all forms of fertility treatment, the process can be emotionally, physically and financially challenging and staff at MFS can give support and, when the patient feels ready, can talk to her about the treatment and give advice on the available options. The clinical and laboratory teams are also usually able to learn something from a failed treatment cycle and can use this information to increase the chance of success for any future treatment.
If a patient decides that she no longer wishes to pursue fertility treatment, she may wish to explore other ways of achieving a family. Stopping fertility treatment can be a difficult decision and MFS staff are able to help a couple through this process and give you contact details for support groups and other agencies.
Read a PDF of the MFS leaflet: ‘Following Unsuccessful Treatment’