EVALUATION BEFORE TREATMENT
Children are a gift from God, and it is God’s desire that we all partake of all His gifts. We here at Origene Fertility are honored that you have chosen us to go on this special journey with you. We promise to do all that we can using all our knowledge and experience and by the Grace of God, you shall be so blessed.
Before we commence any treatment, we would like to evaluate you, to maximize your chances for a successful and healthy pregnancy. Our evaluation includes but is not limited to history taking and physical examination, review of blood test, seminal fluid analysis reports, and transvaginal ultrasound scan at consultation.
The first consultation lasts an average of 90 minutes. We take detailed history using our medical history questionnaire. This is followed by physical examination where we focus on the reproductive organs. At this time, the woman will have a transvaginal ultrasound scan to assess her uterus (womb) and ovaries. This approach gives better information with very little, or no discomfort and we will end the session by performing uterine depth and occasionally mock transfer. This will be followed by further discussion and a review of the results of all tests that have been done. If no test has been done, we have listed the standard test that we do as part of our evaluation and we will review the results at the following visit.
We will request you do the following tests:
1. Ovarian reserve testing
As women advance in age, their ability to get pregnant reduces and the risk of miscarriage increases. The ovarian reserve test tries to measure the reproductive potential by measuring the egg quantity. The tests we use to assess ovarian reserve include:
a. a. Cycle Day 2 ‐5 Follicle stimulating hormone (FSH) luteinizing hormone (LH) and oestradiol (E2): Elevated levels of FSH signifies reduced ovarian reserve. Chances of conception is low in this situation and such women require more drugs during IVF treatment.
b. b. Anti‐Mullerian Hormone Test (AMH): Anti‐Mullerian hormone levels are thought to reflect the remaining number of eggs. This test can be performed on any day of the cycle.
2. Other hormone tests
We test for other organs whose functions may affect the ability to get pregnant and have a baby. They include the thyroid, adrenal, and the pituitary glands assessing the prolactin secreting cells.
3. Infection screening tests
These include: Hepatitis B and C viruses, HIV 1 & 2 and immunity to the rubella virus is determined.
4. Transvaginal ultrasound scan
We use the transvaginal ultrasound scan to evaluate the uterus and in addition to ovarian reserve testing, the ovaries.
5. Uterine depth measurement & mock transfer
We perform uterine depth measurement to know the direction and the depth of the uterine cavity and mock transfer to determine the ease of embryo transfer because embryo transfer is a very crucial stage in IVF treatment and the ease at which the embryo is transferred may affect the outcome of treatment.
Note: Uterine depth measurement may be associated with some transient discomfort.
We may request for other tests like saline infusion sonogram, hysterosalpingogram (HSG) and diagnostic hysteroscopy, depending on the need of the individual.
We evaluate men using semen analysis, and we advise they abstain from intercourse for not more than three days before the production of semen sample for assessment.
In most cases, we will be able to counsel for the best treatment option that may achieve conception at the end of this consultation.
It is important that couples are in the optimal weight range for their heights; excessive weight has been associated with infertility in both men and women, reduced chance of conception with IVF treatment and increased risks of miscarriage. Medical conditions such as hypertension and diabetes should be properly controlled. Cigarette smoking and alcohol consumption should be stopped.
INFORMATION ON SEMEN ANALYSIS
A semen analysis is a test to measure the quantity and quality of your sperm. The laboratory will also measure the amount of semen produced with the sperm. Sperm quality is determined by assessing; the number of sperms, the shape of the sperm and how well they move.
- • You should confirm your appointment for semen production at the Clinic either for:
- Cryopreservation (freezing),
- Or treatment
We advise you to abstain from ejaculation for a minimum of two days and maximum of three days prior to your appointment for semen production because a prolonged period of abstinence (more than five days) may result in a poor sperm sample, which may give an erroneous result.
Do not sit in a hot tub or take a bath in hot water for 3 days before collecting the semen sample, the heat can kill sperm.
Masturbation is recommended for semen production and we advise this. If masturbation is unacceptable to you, you should request for a special condom at the Clinic. This condom is non-lubricated and non-spermicidal; you will be required to pay for the condom. And the last option is interrupted intercourse. The use of non-spermicidal condom and interrupted intercourse are compromised because part of the ejaculate may be lost which, will affect the volume of your semen in the analysis and semen may be contaminated by the bacteria in the vagina.
Wash and dry your hands and penis.
We will provide you with a sterile semen production container, ejaculate into the container. Do not use any lubricant or saliva. Do not use a regular condom to collect the semen, because the oil in it can kill sperm. Collect the entire amount of semen you produce and put the lid back on the container; make sure it is tightly closed.
The Clinic has very comfortable semen production rooms for your convenience. However, we advise you to come to the clinic to collect a semen pot a day prior to your appointment if you prefer to produce your semen outside the clinic. If you produce semen outside the clinic, keep the semen close to body temperature. A good way to do this is by keeping the semen container in an inside pocket. Avoid getting the semen hot or cold. You should get the semen to the Clinic within 60 minutes after ejaculation if you produce outside the Clinic.
If a pubic hair or thread from your clothing falls into the container, do not take it out. The laboratory personnel will take it out using a clean tool.
WHY WE DO INFECTION SCREENING
We would like to share with you the importance of infection screening especially as it relates to reproduction and infertility treatment.
Human immune deficiency virus (HIV), hepatitis B and hepatitis C, are well known infections that are known to be harmful to health. However, during reproduction they can be transmitted both to your partner and your offspring and jeopardize their health.
We screen couples with their consent, carrying out various tests to verify the presence or absence of some infectious diseases, most notably HIV, hepatitis B and hepatitis C.
In addition to our policies and ethics on assisted reproductive technology, we have written this short leaflet to enlighten you about current medical knowledge concerning these infectious diseases and reproductive health.
The presence of one or more of these chronic infections considerably adds to the complexity of your treatments. Therefore, it is of utmost importance to intimate you of our guidelines not only to achieve a successful pregnancy but also to prevent complications.
Human Immune Deficiency Virus (HIV)
Any person can carry HIV‐infection over any period without showing symptoms. Such person can transmit the infection to another person through sexual intercourse, in pregnancy, and during delivery or breastfeeding to the offspring. In addition, such individual carrying the virus can contaminate the laboratory and transmit infection to members of the treating staff for assisted reproduction, thereby potentially causing a threat to other couples receiving treatment.
Therefore, to prevent any contamination and transmission, all patients are requested to undergo an HIV screening test during their diagnostic work‐up. In cases where a new infection with HIV is detected during the infertility diagnostic work‐up, we will refer such person to specialized centers or institutions for further management. Presently, there is no vaccine for HIV prevention and neither is there a cure. Nowadays, it is possible to manage the progression of HIV with various antiretroviral medications. Modern assisted reproductive technology offers the possibility of pregnancy in cases in which the condition of the infection is well under control.
It is important to know that there is a reduced chance of pregnancy; prenatal diagnostic procedure such as amniocentesis cannot be performed because of risk of infecting the amniotic fluid; there is increased risk of complication such as miscarriage and preterm delivery and finally, we are unable to store gametes and embryos of HIV infected couple now.
Hepatitis B virus infection:
Chronic infections with the virus causing hepatitis B constitute a serious health hazard, potentially leading to liver cirrhosis and liver cancer in a small proportion of people who are infected with the virus. Infertility treatment can be performed despite the presence of the hepatitis B infection in one or both partners. In most cases, this virus does not affect the course of the pregnancy. The healthy partner and the new‐born baby can be vaccinated to prevent transmission of the virus and delivery does not have to be through caesarean section.
However, the presence of the virus carries the risk of contaminating both the personnel and the laboratory of the treatment, particularly in those cases in which high concentration of the
hepatitis B virus are found in the blood or in the seminal fluid. Like in HIV, the hepatitis B virus can be washed away from the spermatozoa through the usual semen preparation.
Hepatitis C virus
An infection with hepatitis C has been associated with liver cancer. The course of the pregnancy is unaffected by hepatitis C virus infection. However, depending on the concentration of the virus in the blood of the mother, in approximately 3 to 5 % of all cases, the virus is transmitted to the newborn during mid to late pregnancy or during delivery. However, unlike the hepatitis B virus infection, vaccination of the new‐born is not possible, and delivery through caesarean section is not considered to be necessary. Like the hepatitis B and HIV viruses, the virus causing hepatitis C can be eliminated effectively from the spermatozoa through sperm washing technique.
Rubella (German measles) is an infection caused by rubella virus, but it is usually a mild and self‐limiting infection. This infection in early pregnancy has a very significant damaging effect on the foetus. It can cause either miscarriage or what is known as congenital rubella syndrome. The risks of a baby developing congenital rubella syndrome are greatest in the first 12 weeks of pregnancy. The risk is much lower when pregnancy is more than 20 weeks. The symptoms/components include the following:
• Sensorineural deafness ‐ rubella is the most common cause of congenital deafness in the developed world.
• Congenital heart disease commonly called patent ductus arteriosus or peripheral pulmonary artery stenosis.
• Eye defects including cataracts, congenital glaucoma, pigmentary retinopathy (50% ‐ also‐ called ‘salt and pepper’), severe myopia, microphthalmia (abnormally small eyes)
• Microcephaly (abnormally small head)
• General learning disability
• Insulin‐dependent diabetes, which is often delayed to adolescence or adulthood
Every woman is screened for immunity against rubella by checking the presence and level of rubella (IgG) antibody (body defense) in the blood. We advise any woman who does not have immunity –no antibody‐ to rubella to take MMR vaccine (measles, mumps, and rubella) and avoid pregnancy for two months.
I hope we have been able to explain the challenges of infectious diseases and provide enough information to help you prevent contamination and transmission.
Please feel free to ask questions.
Thank you for doing these tests on time.