Fertility preservation at Liverpool Women's – Guidance for by dfsiopmhy6

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									 Fertility preservation at Liverpool
 Women’s – Guidance for clinicians
 Hewitt Centre for Reproductive Medicine
 Liverpool Women’s Hospital
 Fertility preservation



         Fertility preservation at the Liverpool Women’s- guidance note for clinicians
                                         September 2009

Contact Clinician:                Mr Andrew Drakeley (Consultant Gynaecologist)
Contact Sister:                   Sue Tippin
Medical secretary                 Mrs Viv Wilson

Dear Colleague,

For the last two years we have been offering a fertility preservation service at the Trust. In
summary, we are able preserve the fertility of women who are likely to be rendered
infertile due to medical treatment for other conditions.

     •     For pre-pubescent girls we do not harvest eggs from them but alternatively discuss
           storing eggs from their mother for the daughter’s future use.
     •     For post-pubescent women we offer harvesting and storing eggs for future use.
     •     For women in a stable relationship we harvest eggs, fertilise them to make embryos
           and then store the embryos.

Funding
At present, we apply to the Head of the Extra-contractual Committee for each woman’s
PCT for funding approval. We are in negotiations to improve the funding mechanism.

We must stress that the same eligibility criterion apply for NHS infertility couples:
  • The woman must be childless
  • The woman must be under 40 years of age
  • The woman should have a body mass index between 19 and 30
  • Menstrual FSH <13iu/L (when available)

For women / couples who do not fit the above, they do have the option of self-funding.

Treatment
In order to complete a cycle of ovarian stimulation and harvesting of eggs, two weeks is
required from the next menstrual period. We can see women and start treatment the same
day if that is day one of their period.

Referral
We have developed a fax referral sheet and patient information leaflet. We will endeavour
to see urgent cases within a few days of referral as we often have only a small window of
opportunity to treat these women before definitive treatment of their ailments is required.

Fax: 0151 702 4042
Tel: 0151 702 4212 or 702 4277



Fertility preservation          Prepared by   STi     Date of issue   07/09   Version:1
      Guidance for clinicians   Authorised by CRK     Review date     07/10               Page 1 of 4
                                              MCCN
 Fertility preservation at Liverpool
 Women’s – Guidance for clinicians
 Hewitt Centre for Reproductive Medicine
 Liverpool Women’s Hospital
 Fertility preservation



Fertility Preservation at the Hewitt Centre

What is fertility preservation?

Fertility preservation describes various techniques that enable an individual to protect their
fertility and therefore the chance of having their own biological child. Treatment options
offered by the Hewitt Centre include cryopreservation of sperm, eggs and embryos. At the
moment cryopreservation of ovarian tissue is not funded by the NHS. The following
information refers to egg and embryo freezing.

Who would benefit from egg and embryo freezing?

Childless women who are facing treatment that may affect their fertility such as
chemotherapy, radiotherapy, certain drug therapies or surgical removal of the ovaries.
Also women at risk of premature ovarian failure or certain other gynaecological disorders
affecting fertility.

Embryo freezing

Human embryos have been successfully frozen and thawed for over twenty years.
Although statistically less successful in achieving a pregnancy than replacing fresh
embryos into the womb, using frozen embryos still provides a good chance of pregnancy.
This option is suitable for women in a stable relationship, who wish to have their eggs
collected, fertilised by their partner’s sperm and stored as embryos for their future use.
Choosing this option of fertility preservation has implications for the individual, as both
partners are legal owners of the embryos. Therefore either partner can withdraw or
change their consent at any time preventing the use or storage of embryos by the other
partner. If this causes any concerns we can offer to store both eggs and embryos for the
same couple. The statutory storage period for storing embryos is up to fifty five years.

Egg freezing

This is a relatively new technique that allows eggs to be stored through a process called
vitrification, and then kept in liquid nitrogen for future use. Egg freezing is an ideal
treatment option for women without a partner or in a relatively new relationship. The
women’s consent to store eggs is required before treatment commences and she will be
the sole owner of the eggs retrieved. In theory eggs can be stored for years and still be
viable after warming. According to the Human Fertilisation and Embryology Authority
(HFEA) the permitted time for storing eggs is ten years, which may be extended in blocks
of ten years in certain cases with the necessary consent in place. Initially pregnancy rates
following egg freezing were poor. However, scientific advances in the process of freezing
eggs have now made this a viable fertility preservation option.




Fertility preservation          Prepared by   STi    Date of issue   07/09   Version:1
      Guidance for clinicians   Authorised by CRK    Review date     07/10               Page 2 of 4
                                              MCCN
 Fertility preservation at Liverpool
 Women’s – Guidance for clinicians
 Hewitt Centre for Reproductive Medicine
 Liverpool Women’s Hospital
 Fertility preservation



Ovarian stimulation and egg collection

Fertility drugs are given from the beginning of the patient’s period to stimulate the ovary to
produce eggs. It may be necessary to medically induce a bleed to prevent further delay to
patients waiting to start chemotherapy, radiotherapy etc. Response is monitored using
vaginal ultrasound. After nine or ten days of stimulation, when follicles reach a certain
size, they are pierced by a clinician using a needle under ultrasound guidance. Fluid is
extracted from the ovary then examined by an embryologist for eggs. Not all eggs are
suitable for use. Depending on the patient’s treatment option, eggs are then vitrified or
fertilised and stored for future use. When a women returns to use her eggs at a later
stage they will be fertilised through the process of intracytoplasmic sperm injection (ICSI)
using a partner’s sperm. The resulting embryos will be transferred into the womb as fresh
embryos. This will have been explained and discussed at the initial consultation for fertility
preservation.
For a women returning for treatment who has embryos stored, if warmed successfully they
will be replaced into the womb as part of a frozen embryo cycle. Again, the appropriate
treatment option will be discussed fully at the initial consultation.




Fertility preservation          Prepared by   STi    Date of issue   07/09   Version:1
      Guidance for clinicians   Authorised by CRK    Review date     07/10               Page 3 of 4
                                              MCCN
 Fertility preservation at Liverpool
 Women’s – Guidance for clinicians
 Hewitt Centre for Reproductive Medicine
 Liverpool Women’s Hospital
 Fertility preservation




Fax
To:       Andrew Drakeley                        From:                                         ____________
          Sue Tippin
                                                 Status:                                       ____________
Fax:      0151 702 4042
                                                 Signature:        ____________________________

                                                 Fax:                                          ____________

Phone: 0151 702 4549 / 4277                      Phone:                                        ____________
       0151 708 9988

Re:       Fertility Preservation                 Cc:                                           ____________

Date:                                            Pages:                                        ____________


Patient name:                                                                                  ____________

Age / DOB                                                                                      ____________

Patient contact details
Address & telephone               _________________________________________________

                                                                                               ____________

Reason for referral
i.e. disease

Fulfils NHS eligibility
i.e. (childless and under 40
if not, willing to consider
self funding)

Next period due

Chemo/radio/surgery
Can wait till 2 weeks after
next period

Comments




Fertility preservation          Prepared by   STi          Date of issue   07/09   Version:1
      Guidance for clinicians   Authorised by CRK          Review date     07/10                     Page 4 of 4
                                              MCCN

								
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