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                   FERTILITY CLINIC
Problems with conceiving are a common and distressing problem affecting at
least one in six couples. If you have been handed this sheet it is likely that
either you or your doctor suspect that there may be a problem in this area and
we very much hope that we can help to resolve this situation. Infertility occurs
equally in men and women and can occur readily in those who have had or
been responsible for a previous pregnancy. Quite often we discover a clear
reason but sometimes there is a combination of problems or no definite reason
is found.


The Department of Health advises all women who are actively planning a
pregnancy to take a 400 microgram folic acid tablet daily as this has been
shown to reduce some birth defects.               These can be bought from
supermarkets, health food shops or chemists. It is fine to take folic acid every
day for the whole time you are trying for your baby.

Women with diabetes or who are taking medication for epilepsy, or have had
an infant with a neural tube defect require a higher dose of Folic Acid (5 mg per
day). Your General Practitioner (GP) will need to prescribe this.

It is very important for the woman to work out her cycle lengths over the
last year or so. To work out the cycle length, count from the first day of
bleeding in one cycle to the first day of bleeding in the next cycle e.g. if a period
starts on the 1st August and then another period starts on the 30th August this
would be a 30 day cycle. Even if there appears to be no pattern to your
bleeding please still calculate all cycle lengths.

We would normally expect that ovulation is occurring (an egg being released) if
the cycle length is between 25 – 42 days. It is not unusual for women to bleed
only occasionally, e.g. every 70 or 90 days. Please still calculate the frequency
of the bleeds. Please bring a list of all cycle lengths with you to any future
appointments (at your GP surgery or the Fertility Clinic).

The following information has been shown to significantly improve
fertility. For the majority of couples if you make the necessary changes
and time intercourse to the fertile time pregnancy should happen.


At your first appointment we usually do the height and weight of the female
partner. For many women if they become underweight or overweight this can
prevent ovulation (an egg being released). Being underweight or overweight
will lower your chances of getting pregnant and increase the risk of certain
problems in pregnancy. There is a greater chance of miscarriage if you are
overweight. Before making your first appointment, if you have very irregular
cycles or no cycles, this could be an excellent opportunity to see if a change in
your weight will allow a more regular ovulatory cycle and pregnancy! We have
found for the vast majority of women, if they are overweight and lose 10% of
their weight, many will start to have a spontaneous ovulatory cycle. It appears it
is the weight change involved that allows ovulation, not necessarily being at the
ideal weight. Once cycles commence (25-42 days) most couples will have a
baby naturally and never need medical treatment.

Quit Smoking

Smoking has been linked to infertility and miscarriage. Smoking leads to an
earlier menopause (up to two years earlier!) and lower sperm counts. The NHS
offers plenty of free help and support for people who want to give up smoking.
Evidence shows that getting professional advice and using nicotine replacement
can quadruple your chances of stopping for good. To contact Peterborough
Stop Smoking Tel; 0800 376 5655 or text them on 07884 313 482.



Just nine units of alcohol a week can mean that it can take you twice as long to
conceive – a unit being a small glass of wine, half a pint of normal strength beer
or a small glass of spirit. Drinking too much alcohol can also increase your risk
of miscarriage and will affect the quality of your partners sperm. For men,
excessive alcohol intake can have a severe effect on semen quality. Limit
yourself to no more than one or two units a night while your partner should stick
to less than two or three units. Both of you should try to have a few alcohol free
days during the week.

Avoid drugs

Street drugs such as marijuana or cocaine do affect fertility so it’s best to steer
clear of them. Some prescription drugs are also not recommended when you
are trying for a baby or during pregnancy. Ring the medicines information line to
find out if a medication could cause problems conceiving or in early pregnancy.
Tel: 01733 677303. Talk to your GP who may suggest an alternative medication

The following investigations must be carried out by your Practice Nurse
or GP before a first appointment is arranged in the clinic.

Please see the check list at the end of this information sheet.


Your Practice Nurse/GP can arrange for the woman to have blood taken during
the second half of the menstrual cycle. (This test is called a progesterone blood
test). This is taken to check that ovulation is occurring. At the same time as
checking the progesterone blood test it is usual to screen whether you are
immune to German Measles (Rubella). Both of these tests can be done at the
same time. If your cycle is irregular your Nurse/Doctor may decide to test the
progesterone level on day 21, day 28 and day 35 of the cycle instead of the
usual day 21 progesterone. If you do not currently have periods there is no
need to test the progesterone levels.
Your Nurse/Doctor may also request a set of Baseline Hormones, particularly
if your cycles are irregular or if you don’t have periods, before you are seen in
the clinic (FSH, LH, estradiol, testosterone, TSH, prolactin).

If the baseline hormone blood test has already been carried out we will not need
to repeat this as long as it has been done at the correct time in your cycle. It is
important to have these tests done when your hormones are very quiet. We
usually ask for the blood test to be done on Day 1, 2, or 3 of the cycle (the first,
second or third day of bleeding).

If you experience very long cycles this blood test can be done any time after
day 42 of the cycle or if you have no periods the blood test can be done at any

Where to get blood tests done (available weekdays):

   Your surgery
   Peterborough City Care Centre, Thorpe Road, Peterborough (open
    07.00—16.00 week days).

If any of the blood tests you need fall over a weekend it is fine to come on the
nearest weekday. For example, if you need a blood test on the Saturday please
have this done on the Friday; if you need it on a Sunday please have the test on
the Monday.


Usually the male partner will be asked to bring two sperm specimens (it is
important the tests are done approximately three months apart) to the
laboratory for examination. A full instruction sheet about handing in the semen
specimen will be given to you at your surgery. If two samples have already
been tested at Peterborough City Hospital you probably will not need to do any
more. The sample should be done at home. We usually advise that you
produce the sample at approximately 9.00 am at home and bring this into the
laboratory before 10.00 am on the day of your semen analysis appointment.

There is a very good chance that if you make some of the changes outlined in
this information sheet, along with focusing sexual intercourse to the fertile time
you may not need to book an appointment in the Fertility Clinic. Along with this
information sheet we also recommend that you read the information sheet titled
“Timing of sexual intercourse for your fertile time” and the information sheet
about organising a semen analysis test. All of these information sheets are
available from your surgery, the most up to date copies can be downloaded
from the hospital intranet site which your GP or Practice Nurse has access to.

If after a minimum of two to three cycles no pregnancy has happened
please see your GP or Practice Nurse to see whether it would be useful to
book an appointment with the Fertility Clinic.


We always see both partners at the Fertility Clinic. It is important that you both
attend so that the Fertility Nurse Specialist or Consultant can ask you both the
relevant questions. Please allow one-two hours to visit the Fertility Clinic for
your first consultation. 80% of consultations are carried out by the Fertility
Nurse Specialists. Information about previous illnesses and operations is
very useful.

Do not forget to bring a list of all medications you are taking and most
importantly the list of all your cycle lengths.


There are two different methods of assessing the female partner’s Fallopian
tubes, either hysterosalpingogram or laparoscopy and dye. At the second
appointment the most suitable type of investigation for your situation may be
discussed. It is recommended before either test is carried out that the female
partner has a screen for Chlamydia. This is a simple test and is much like
having a smear test. You may decide, after discussion in the clinic, not to have
either tube test done, or perhaps to delay these tests, depending on your

After every appointment we usually write to the female partner’s doctor to let
them know how things are going. It is important that your GP is aware of any
treatment/investigations so that he/she can give you the best/safest advice if
you should see them at any time. Please let us know if you have any concerns
about us writing to the female partner’s GP about you both.


Counselling is an important part of your care. It is routinely offered to all
couples attending the fertility clinic.      The difficulty of conceiving, the
investigations and treatment, frequently causes stress and anxiety. Counselling
offers an opportunity to explore your thoughts, feelings and beliefs in order to
help you come to terms with your present situation. If you would like to meet
our counsellor please phone 01733 673766 for an appointment. She is happy
to see you at any stage, either before or during investigations, for support whilst
having treatment or afterwards. Please leave your name and a contact
telephone number when you phone.


At the follow up consultation you will both be given the results of your tests and
any further investigations will be organised as needed and these will be
explained to you. It may be possible at this stage to accurately diagnose the
problem causing your infertility, in which case the outlook and any treatments
which are appropriate will be discussed with you. In a proportion of couples we
do not find an obvious reason. In many cases, particularly that of unexplained
sub-fertility, often time will allow a pregnancy to occur. You can be reassured
that most couples who attend this clinic will have a baby. Your clinician will be
able to give you an idea of the likelihood of this happening depending on your
individual results and situation. If, after a specified length of time pregnancy
has not happened then some assisted conception treatments may be advised.
We hope that this information sheet has guided you through some of the initial
investigations and has given you some indication of what to expect when
attending the clinic. Please remember that the purpose of the clinic is to help
you and if you are uncertain or unhappy about anything please discuss this with
the Fertility Nurse Specialists or Consultant. Never be afraid to ask questions.

Any comments that you have about our services that can help us improve the
quality of the services we provide are welcome.

If you have any suggestions please let us know at the time of your appointment
or by contacting the Clinical Nurse Specialist Office, telephone number below.

We welcome complements as well as criticisms. If you feel that we are not able
to help you within the Fertility Unit you are welcome to contact the Patient
Advice and Liaison Services (PALS). This Department should be able to help
you resolve any problems or concerns quickly and speedily. The PALS team
can explain the complaints procedure if needed.

If you have any queries please telephone your surgery. Once you have been
seen in the clinic, if you have any concerns or questions please telephone the
Clinical Nurse Specialist Office at the Fertility Clinic - 01733 673750. Please
leave a message and we will return your call as soon as possible.

Women’s Health Outpatients, Fertility Unit, Peterborough City Hospital, Edith
Cavell Campus, Bretton Gate, Peterborough, PE3 9GZ

Reference: FPH/194
Clinical Business Unit: Family and Public Health
Department: Fertility
Author: Fiona Wynn
Review Date: September 2012

Checklist of investigations that must be done by your GP or Practice
Nurse before arranging an appointment in the clinic.

    Name of test                       Date test   Result

F   Rubella (see page 5)
    Progesterone blood test to check
    for ovulation (see page 5)
L   Baseline hormones (FSH, LH,
E   TSH, estradiol, testosterone,
    HORMONES         IF     CYCLES
    CYCLES (see page 5)
    Chlamydia screen (see page 8)

M   1) Semen analysis (to be brought
A   to Peterborough
L   City Hospital Lab)
E   (see page 6)

All GP practices in the Peterborough area have copies of our quick
reference guide explaining in detail all of the above tests. GP surgeries
have access to the most up to date copies of this through the hospital
intranet site.


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