Female Fertility
“I would recommend that someone comes along for a fertility consultation if they've been trying to fall pregnant for more than six months and they're over the age of 35 or more than 12 months and they're under the age of 35.”
— Dr Myvanwy McIlveen
Let's Explore
When Should I Have Kids?
Tubal Flushing (Hysterosalpingogram/HSG)
How long have you been performing tubal flushes?
The doctors at Newcastle Fertility Specialists have been performing their own HSGs for over 20 years. Whilst most gynaecologists will refer you to a radiologist, we do the test ourselves, offering a level of personalised service and skill unique to our practice.
What does the tubal flush test involve?
A speculum, is inserted into the vagina and then a small catheter (tube) placed into the cervix. We then inject 5-10ml of x-ray contrast dye from a syringe. As the dye fills the uterus, it passes into the fallopian tubes and then comes out the end of the tubes around the ovaries. Our female radiographer then takes x-rays, giving us an outline of your uterus and tubes.
What is a tubal flush?
A tubal flush is a way of checking that the fallopian tubes are open and free of blockages. It also has the added benefit of improving pregnancy rates and is far less risky than a laparoscopy. About 30-40% of younger women who have an HSG will fall pregnant within 6-12 months and not require additional treatment.
Are there any risks involved?
Some people experience period-like cramps during the procedure or report feeling faint during or after the procedure. Rarely, infection can be introduced into the pelvis. For some people, a HSG cannot be performed due to technical difficulties such as having a narrow cervix.
What are the benefits of having a laparoscopy instead?
If we suspect you have endometriosis or adhesions, we sometimes prefer to do a laparoscopy so we can treat any pathology present. Some people cannot tolerate a HSG and would prefer a laparoscopy, which is done under a general anaesthetic. Before deciding on any procedure, we’ll discuss the pros and cons of each with you based on your personal situation.
Ovulation Irregularities
In cases where ovulation is infrequent or absent, fertility may be adversely affected. However, this doesn’t mean that pregnancy is impossible. In such instances, medical intervention may be required but we recommend an initial fertility assessment is recommended.
What if my ovulation is irregular? Irregular Ovulation:
Inconsistent or irregular ovulation may be attributed to hormonal imbalances or underlying health conditions.
What if I’m ovulating less? Luteal Phase Deficiency:
A shortened luteal phase in the second half of the menstrual cycle after ovulation, can pose challenges to the successful implantation of a fertilised egg in the uterus.
What if I’m not ovulating at all? Anovulation:
The complete absence of ovulation can result from hormonal imbalances, stress, excessive exercise, Polycystic Ovary Syndrome (PCOS), or other medical conditions.
What is the AMH Test?
When we are born, we’re born with a supply of eggs. The older you get, the more this supply decreases in quantity and quality. The AMH blood test measures how many eggs you have remaining and what age menopause will be.
The AMH test gives us a gauge for your ovarian reserve (quantity) but unfortunately can’t tell us about your egg quality. Egg quality decreases with age but we cannot test or measure egg quality. We know that egg quality decreases with age, but sadly there is no test to measure egg quality.
Endometriosis
What is endometriosis?
Endometriosis is a chronic medical condition where there is a presence of tissue of the uterine lining growing outside the confines of the uterus. This condition often causes pain, premenstrual spotting may be associated with blocked fallopian tubes.
Is IVF recommended for endometriosis?
Endometriosis can lead to pelvic scarring, tubal dysfunction and diminished egg reserve, all of which can reduce natural fertility. IVF offers an effective solution by achieving fertilisation outside the body away from the affected pelvis, and then transferring the resulting embryos into the uterus, bypassing the endometriosis. We often recommend IVF if surgery wasn’t successful, or if you prefer this rather than surgery.
Blocked Fallopian Tubes
It’s possible for your fallopian tubes to become blocked. Blocked tubes can occur after surgery or infection. The tubes play a vital role in transporting eggs from the ovaries to the uterus and providing a conduit for sperm to fertilise the egg.
Several causes contribute to blocked tubes, including:
Pelvic Inflammatory Disease (PID):
Infections can cause inflammation and scarring within the fallopian tubes.
Endometriosis:
Endometriosis can lead to adhesions and tubal blockages.
Previous Surgical Interventions:
Prior abdominal or pelvic surgeries, such as appendicitis or ectopic pregnancy procedures, can lead to the formation of scar tissue, obstructing the tubes.
Ectopic Pregnancy:
Occurring outside the uterus and often within the fallopian tube, ectopic pregnancies can result in damage or removal of the tubes.
How do blocked tubes impact fertility?
Blocked tubes make it hard for the egg and sperm to meet, making natural conception difficult. In cases where fertilisation does occur, but the egg can’t move through the blocked tube to the uterus, an ectopic pregnancy may result, which is a serious medical concern.
How do you diagnose and treat blocked tubes?
The diagnosis of blocked fallopian tubes typically involves a comprehensive assessment, including a review of medical history, physical examinations, imaging tests, and minimally invasive procedures such as hysterosalpingography (HSG). In a HSG, contrast dye is introduced into the uterus and X-rays are taken to visualise the fallopian tubes.
Treatment strategies vary based on the severity of the blockage. Mild blockages may be treated through day surgery like laparoscopy to enhance tube function. In cases of severe or irreparable blockages, assisted reproductive technologies such as IVF can be used to bypass the fallopian tubes, increasing the likelihood of pregnancy.
Polycystic Ovary Syndrome (PCOS)
What is PCOS?
Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that can impact any person with ovaries. Those affected can suffer a variety of symptoms including irregular menstrual cycles, elevated androgen (male hormone) levels, and the presence of multiple small follicles on the ovaries. Although these follicles give the syndrome its name most people with PCOS do NOT have ovarian cysts; instead, they have lots of small follicles containing eggs.
What causes it?
We don’t know the exact cause, but PCOS is believed to result from a combination of genetic and environmental factors. Insulin resistance is frequently associated with PCOS and can contribute to increased androgen levels and disruptions in the normal menstrual cycle.
What are the common symptoms?
Symptoms of PCOS can include irregular or infrequent menstruation, or even amenorrhea (absence of periods altogether), making it a leading cause of infertility. Other common symptoms include acne, facial hair growth, difficulty losing weight, and abnormal vaginal bleeding.
How do you diagnose PCOS
PCOS is diagnosed using a combination of symptoms and lab testing. We use ultrasound imaging to visualise the ovaries and do a follicle count, and a blood test to measure hormone levels, including oestrogens, androgens, LH, FSH, prolactin, AMH, glucose and insulin.
How do you treat PCOS?
Treatment strategies depend on what your symptoms and goals are. Lifestyle modifications, including diet and exercise, can be helpful if your BMI is over 25. For those wanting to conceive, we often start oral medications like letrozole (Femara) & clomiphene (Clomid), followed by blood tests to check if you are ovulating. If the medications are not successful, hormonal injections or IVF may be tried. In rare cases, we may offer laparoscopic ovarian drilling, a surgical procedure that can correct ovulation issues in women with PCOS.
For weight loss we recommend seeing your GP to discuss options. They may recommend a dietician, an exercise physiologist or weight loss medications such as Saxenda, Contrave or Duromine. We do not recommend Ozempic because of its long half-life when trying to conceive. Some patients with insulin resistance may be started on metformin (Diaformin) which helps lower insulin levels.
Is IVF safe for patients with PCOS?
It can be trickier to do IVF for a person with PCOS if their egg count is very high. We don’t want to get too many eggs all at once and make you feel unwell (Ovarian hyperstimulation syndrome). The good news is that with modern IVF stimulation techniques, IVF has become much safer and women with PCOS have more opportunities than ever to safely conceive.
Endometrial PRP Treatment
Endometrial PRP for Recurrent Implantation Failure and Thin Endometrium
Platelet Rich Plasma (PRP) is a new supporting fertility treatment option for women who have had Recurrent Implantation Failure (RIF) following IVF embryo transfer.
PRP has a four-to-five-fold higher concentration of platelets than normal plasma and is separated from whole blood via centrifugation. PRP has been used widely across various medical disciplines to promote healing and tissue regeneration, including heart disease, neurological damage, sports injuries and skin therapy.
The goal of Endometrial PRP therapy is to increase endometrial receptivity, which are thought to be key factors for embryonic implantation.
What is the evidence for Endometrial PRP?
Endometrial PRP for women with RIF involves infusing growth-factor-rich platelets directly into the uterus. PRP contains over 200 growth factors and cytokines – protein signalling molecules that are believed to enhance endometrial receptivity, support embryo development, and improve pregnancy outcomes for some women. Early studies suggest evidence of benefits, but the data is not yet conclusive and further are needed fully establish its effectiveness.
What are the potential risks of Endometrial PRP?
Endometrial PRP is considered a low-risk and relatively safe procedure, however, as with any invasive procedure, there is a slight risk of infection. The procedure is performed under sterile conditions to minimise risks however, you should watch for signs of infection including increased pain, fever or unusual discharge.
Endometrial PRP therapy does not guarantee improved fertility or a successful pregnancy. Its effectiveness can vary between individuals and success may depend on various other factors.
Am I suitable for Endometrial PRP?
Endometrial PRP is not suitable for individuals with blood or platelet disorders, those undergoing certain treatments, or with specific medical conditions. We can’t use PRP if you are on aspirin. Our doctors can evaluate your suitability and discuss the potential benefits during your next appointment. The PRP treatment is performed through Genea Newcastle. Your Newcastle Fertility Specialist can assess your suitability & discuss the possible benefits at your appointment. The PRP treatment is conducted through Genea Newcastle.