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JIVA Fertility

FAQs

What is infertility?

Infertility is a disease of the reproductive system and is defined as ‘the failure to achieve a pregnancy after 12 months of regular unprotected sexual intercourse in a heterosexual relationship.
Infertility affects millions of people worldwide. The World Health Organisation estimates that approximately one in six individuals of reproductive age experience infertility.

What are our chances of conceiving?

It is estimated that if the female age is less than 40 years; your menstrual periods are normal; you both do not have any medical problems and are able to have regular (2-3 times per week), unprotected sexual intercourse in a heterosexual relationship, at least 80 out of 100 couple in your circumstances conceive within the first 12 months of trying. Half of the remaining couple go on to conceive within the next 12 months.

When to seek help?

It is not unreasonable to request a private Fertility Clinic appointment ANYTIME, if you wish to have more understanding of your reproductive health for reassurance or to discuss fertility options.

We encourage you to seek help after 12 months of trying if pregnancy has not happened in a heterosexual relationship.

However, we will be happy to see you sooner or even before trying if:
- Female partner is 36 years of age or older OR known to have gynaecology condition such as endometriosis, PCOS, fibroids or has had chlamydia infection or operation on ovaries or fallopian tubes
- Male partner has a history of undescended testes, injury to or operations on the scrotum, mumps after puberty
- Either of you suffered a medical condition that required treatments affecting fertility, such as chemotherapy or radiotherapy

I want to have two children, when should I start trying for pregnancy?

Fertility declines with age, both natural and assisted conception related. The below table is based on the information from a study. This gives you an idea of when to start trying for a pregnancy depending on the family size desired. This applies to natural conception and is different to assisted conception treatment. So, for you to be 90% certain of a two children family, you should start trying for pregnancy by the age of 27 years or sooner.
‍

3 Children

2 Children

1 Child

Chances of achieving family size

23 years

27 years

32 years

at least 90%

31 years

34 years

37 years

<= 75%

35 years

38 years

41 years

50%

Ref: Habbema, J. D. F., Eijkemans, M. J. C., Leridon, H., & te Velde, E. R. (2015). Realizing a desired family size: when should couples start? Human Reproduction, 30, 2215-2221.

What is a fertile period?

Fertile window is a specific time during each menstrual cycle when you have the best chances of conceiving, which is generally around the release of the egg (ovulation) from the ovaries. It is predicted that most pregnancies happen if you have sexual intercourse starting from six days prior to ovulation and ending on the day of ovulation. As most women do not know when they ovulate, it is recommended the couple have regular sexual intercourse, every 2-3 days.

Should I be using ovulation kits or fertility tracking apps when trying to conceive?

There are many fertility tracking apps available for menstrual cycle tracking. You can use them for recording your menstrual cycle as they give information about any concerns with menstrual regularity.

There are many ovulation kits available which predict ovulation by detecting certain reproductive hormones in the urine. We generally do not recommend using ovulation testing kits when trying for pregnancy as you are likely to miss some crucial days in the fertile period (see above). This may also add to the psychological stress caused by infertility. We recommend for the heterosexual couple to have regular sexual intercourse, every 2-3 days, throughout the menstrual cycle for best chances of a natural conception.

How can I optimise my chances of conceiving?

We encourage you:
To have regular sexual intercourse, at least 2-3 times per week
Make healthier lifestyle modifications:
    - stopping smoking,
    - maintain healthy weight
    - undertake moderate exercises regularly, at least 4-5 times a week
   - limit excessive alcohol consumption to 1 unit per week or even stop it
   - stop using recreational drugs
    - get enough sleep
    - manage stress effectively

Is there a diet that can help with fertility?

We recommend you to maintain healthy dietary patterns and eat a properly balanced diet with a high consumption of whole grains like brown rice, oats and wholemeal bread, monounsaturated or polyunsaturated oils, fruits and vegetables, oily foods such as fish, nuts and seeds and low salt intake.

We encourage you to avoid sugar, saturated fats from dairy products, fast foods rich in trans fats, processed meat/food and artificial sweeteners, and cut down caffeine intake.

We have a dedicated, independent Dietician-Nutritionist who can provide appropriate guidance. Please visit https://yourgreekdietitian.com/ to book a Discovery Call with Maria Kolotourou.

Do you recommend any vitamin/food supplements?

The Department of Health recommends that all women planning a pregnancy take a daily supplement of 400 mcg of folic acid (Vitamin B9) starting three months before conception and for the first 12 weeks of pregnancy to minimise the risk of baby developing neural tube defects, such as spina bifida. Some women need high dose (5 mg/day) which we will advise at your appointment.

The Public Health England indicates that everyone including pregnant and lactating women require a daily intake Vitamin D in the dose of 10 mcg per day (400 IU/day). The British Fertility Society suggests formal measurement of vitamin D levels, especially in high-risk groups which we will discuss at your appointment.

We encourage men to STOP using protein supplements or steroids.

We have a dedicated, independent Dietician-Nutritionist who can provide appropriate guidance. Please visit https://yourgreekdietitian.com/ to book a Discovery Call with Maria Kolotourou.

We have been trying to conceive for 24 months now, we have not conceived, what are the possible reasons?

The common causes of infertility are:
- Female age - natural fertility declines with age.
- Problems with ovulation are responsible for infertility in 25% (one in four) of couples, damage to fallopian tube/s in 20% (one in five) couples and in about 10% (one in ten), it is due to either problems with the womb (fibroids or adenomyosis) or peritoneum (endometriosis).
- In about 30% (almost one in three) of couples, it is due to sperm abnormalities.
- Combination of factors in both man and women in about 40% of infertile couples.

Despite many tests, we are unable to find a cause for infertility in about one on four (25%) couples.

Can stress affect fertility?

Occasional stress is not likely to affect fertility, however chronic stress may cause hormonal imbalance and can cause problems with ovulation. Finding healthy ways to manage your stress can be beneficial for fertility.

What is an AMH test?

Anti-Müllerian Hormone (AMH) is a hormone produced by the egg containing sacs (primordial or pre-antral folicles) in your ovaries. AMH can be measured through a simple blood test which can be done in any part of your menstrual cycle

As women get older, there is a reduction in the number and quality of eggs in the ovaries which varies between women. AMH levels will provide us an indication of the number of eggs remaining in your ovaries (egg reserve or ovarian reserve) and also to predict your ovaries response to medications during fertility treatment. We use the AMH to tailor treatment protocols to optimise the number of eggs we get and to minimise complications such as OHSS.

The AMH levels can be affected by hormonal contraception, and hence we would advise stopping contraception for 3-6 months for accurate results.

What is antral follicle count (AFC)?

Antral follicles are the egg containing sacs (follicles) that can be seen in your ovaries when we perform a trans-vaginal ultrasound scan (internal scan). AFC is another good marker of your egg reserve.

Evaluation of Fallopian Tubes Patency

Fallopian tubes are two organs attached to the top of the womb (one on each side) and they help in picking up the egg once released from the ovaries and then transporting it towards the womb cavity.

One in five women with infertility have problems in their fallopian tubes. The fallopian tubes can be damaged by vaginal/pelvic infection, or inflammation due to endometriosis or previous surgery or even smoking, which can prevent the successful meeting of sperm and egg.

A HyCoSy (Hysterosalpingo-Contrast Sonography) is an outpatient procedure done to check the patency of the fallopian tubes. A small catheter is passed inside the womb cavity. A contrast/foam is injected through the catheter and an internal ultrasound scan is done to check the contrast/foam flowing through the fallopian tubes into the pelvis if the tubes are open. Most tolerate the procedure well and we advise you take simple pain killers such as paracetamol and ibuprofen (if you are not allergic to) one hour before the procedure.

A HSG (Hysterosalpingogram) is a procedure similar to HyCoSy, but x-rays are used instead of the ultrasound scan - this is not available through JIVA Fertility

Some may need a day case surgical procedure called Laparoscopy and dye test under general anaesthesia which will be advised to you either at the first appointment or after HyCoSy. This procedure will be offered through Mr Harish Bhandari's private clinic at Nuffield Hospital, Leeds

Semen Analysis - How do I prepare myself?

Semen analysis is a test to assess sperm parameters in semen such as number (Concentration or Density), motility, and morphology which provide crucial information about male fertility and reproductive health.

You must have a 2-5 day abstinence period prior to the day of your semen analysis.

If you have not been well with fever within the last week, or you are on antibiotics for infection, we advise you to wait TWO weeks before attending for semen analysis.

If the Semen Analysis is included in your chosen Assessment Package, a detailed explanation of the results, and appropriate advice will be given to you at your appointment. If not, please arrange an appointment (at an extra cost) to discuss the results with our Consultant.

What is Ovarian Hyperstimulation Syndrome (OHSS)?

Ovarian Hyperstimulation Syndrome (OHSS) is a condition that can occur in women undergoing fertility treatments, due to an exaggerated response to hormone medications used to stimulate ovaries to produce eggs.

Symptoms of OHSS can range from mild to severe which generally start within a few days of using hormone medications and ocassionally at a later date (late-onset).

The risk is higher if you are young, slim, have Polycystic ovary syndrome (PCOS) or polycystic ovaries.

We are committed to reducing the risk of OHSS by using various strategies during fertility treatments.

What are the fertility treatment options for infertility?

We offer three types of fertility treatments for infertility:
- Medical treatment with the use of medications (such as letrozole, clomifene citrate or gonadotropins) to induce ovulation if you are not releasing the egg (ovulation) regularly.
- Surgical treatment to improve fertility - Laparoscopy for ablation of stage 1 or 2 endometriosis or to repair of blocked fallopian tubes or release pelvic adhesions; surgical removal of fibroids (open operation or by Hysteroscopy, depending on the location of fibroids); Hysteroscopy for removal of endometrial polyps or to release adhesions (scarring) inside the womb cavity or for womb cavity abnormalities.
- Assisted reproduction techniques such as intrauterine insemination (IUI), in vitro fertilisation(IVF), and intracytoplasmic sperm injection (ICSI).

What is Ovulation Induction (OI)?

Ovulation induction medications, are used to stimulate follicles (egg containing sacs) in your ovaries to produce and release egg (ovulation) regularly. They will also be used to control the time you release eggs, so intrauterine insemination (IUI) can be scheduled at a time that is most likely to result in pregnancy.
Please refer to our OI Information Page for more details.

What is Intra-Uterine Insemination (IUI)?

Intrauterine Insemination (IUI) is a fertility treatment that involves placing sperm directly inside a woman’s uterus (womb) around ovulation to facilitate fertilisation.
Please refer to our IUI Information Page for more details.

What is In Vitro Fertilisation (IVF)?

IVF is a fertility treatment where eggs are retrieved from the ovaries after stimulating them using medications and are fertilised with sperm in laboratory. After few days one (very ocassionally two) embryo is transferred inside the womb, for implantation to occur, bypassing the fallopian tubes.
Please refer to our IVF Information Page for more details.

What is Intra Cytoplasmic Sperm Injection (ICSI)?

ICSI is similar to IVF treatment, but instead of allowing sperm to fertilise the egg naturally in laboratory, a good quality sperm is injected into the cytoplasm of the egg under microscope guidance.
Please refer to our ICSI Information Page for more details.

What is Frozen Embryo Treatment (FET)?

Advances in embryo freezing (cryopreservation) technology have made frozen embryo treatment (FET) a fertility treatment option which will give you another opportunity to achieve pregnancy without having to undergo stimulation of ovaries or the egg collection procedure.

We can freeze good-quality embryos during an IVF/ICSI treatment cycle which can later be thawed and transferred inside the womb cavity, after suitable preparation of the endometrium (lining of the womb). Please refer to our FET Information Page for more details.

Using donated sperm, eggs or embryos

We will discuss with you about using donor gametes or embryos if:
- You are in a same sex relationship
- You wish to have fertility treatment as a single parent
- You are not producing eggs or sperm of your own
- Your own sperm or eggs are not likely to result in a pregnancy
- You have a high risk of passing on an genetic condition

Before you make a decision about using a donor, we encourage you to read the information available on the Donor Conception Network, and we will arrange an Implications Counselling with our Senior Specialist Fertility Counsellor.

What is Surrogacy?

Surrogacy is a process when a woman carries and gives birth to a baby for another person or couple.

Surrogacy may be appropriate for women if they have a medical condition that makes it dangerous for them to conceive or give birth or if it is impossible for them to get pregnant, either due to absence or malformation of the womb or they have experienced repeated pregnancy losses or IVF failures.
It is an option for single-men wishing to father a child as a single parent or for male same-sex couples who want to extend their families.

What is Fertility Preservation?

Fertility preservation is a process which allows you to freeze your gametes (eggs or sperm) for future use, giving you the choice of when to start a family. The number and quality of eggs decline with ageand the best time to freeze your eggs is before you are 35 years of age.
Please refer to our Fertility Preservation Information Page for more details.

What are treatment add-ons?

Treatment add-ons are optional, additional, non-essential treatments that may be offered along with proven fertility treatments (IUI/IVF/ICSI) for various reasons, with a view to:
- Improve chances of having a baby
- Reduce the risk of miscarriage
- Reduce complications of fertility treatment.

For most patients, treatment add-ons are not required; however it may be justifiable in some circumstances for using the treatment add-on as part of the proven fertility treatment. At JIVA Fertility, we will be able to discuss with you whether a treatment add-on would be appropriate for your personal circumstances.

Come & Visit Us

New York, NY 10001

123 Main Street

Apt 4B

Contact: +123 456-7890

Los Angeles, CA 90012

456 Elm Avenue

Suite 300

Contact: +122 555-1212

This site is for information purposes only and is not a substitute for medical consultation, diagnosis, or treatment. We suggest arranging a suitable specialist appointment if you wish to discuss your medical issues.