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For couples with fertility problems, trying to start a family can be a very distressing time. The fact that one in seven couples need medical assistance of some sort may not be of direct comfort when you are suffering yet another disappointment, but it does mean that a great deal of research is being done into infertility, and there are experienced specialists ready to help you through the process. Your first step is to see your GP who will then recommend a specialist, such as female gynaecologist Miss Amanda Tozer, to investigate the cause.

What will happen at the initial fertility consultation?

Before undergoing any tests at Amanda Tozer’s London fertility clinic, you will first talk about your medical history. Miss Tozer will then conduct a physical examination and run several diagnostic tests. These may include: semen analysis; a pelvic ultrasound to check for abnormalities such as fibroids; tubal patency tests whereby the Fallopian tube is checked for any blockages that would obstruct the egg’s movement from ovary to uterus; hormone tests to check ovulation and for imbalances; and saline sonography. Saline sonography is a means of detecting uterine abnormalities and is conducted using a transvaginal catheter through which saline is injected; the saline distends the uterine cavity, allowing abnormalities to become visible on the ultrasound. The results of this test are available immediately.

Individualised care in fertility treatments

A highly experienced female gynaecologist, Miss Amanda Tozer has helped many couples who have had repeated setbacks in either getting pregnant or carrying a baby to term. At her London fertility clinic, couples receive specialist, attentive and personal care; Miss Tozer personally conducts the tests, she talks through each step of the process at length and encourages her patients to ask questions no matter how small – and she can always contacted via her personal phone.

Fibroids are benign growths in the womb and are extremely common: an estimated one in four women will have fibroids at some stage in their life. However, many women will not know they have fibroids as only one third of cases present symptoms; these can include heavy and prolonged periods, swelling, post coital bleeding and infertility. They vary both in size – from that of a small pea to a large grapefruit – and location, the most common of which is within the muscle tissue of the womb (intramural fibroids).

Surgery is not always necessary

Fibroids do not always cause symptoms or they may only be mild; if this is the case, you may not require any treatment. Furthermore, fibroids tend to shrink after the menopause and symptoms ease. There are also medication options to manage the symptoms.

Fibroids and fertility treatment

During your consultation at Miss Amanda Tozer’s London fertility clinic you will initially undergo an ultrasound scan; sometimes an MRI will be required to locate and establish the size of multiple fibroids. Miss Tozer, a female gynaecologist with many years’ experience of treating fibroids, will then discuss the results with you, explaining the implications, if any, regarding your fertility. If the fibroids lie in the muscle tissue (intramural) and are smaller than 5cm, it is unlikely that removal will be recommended.

However, larger intramural fibroids can be removed either in an open procedure or laparoscopically, depending on their location. If Miss Tozer identifies fibroids growing from the inner wall into the middle of the womb (sub mucosal fibroids) she will most likely recommend they be be resected before you embark on fertility treatment. Resection of sub mucosal fibroids entails a hysteroscopy, usually performed as a day case; in some cases, pre-op suppression of hormones will be required.

At the London Clinic, Miss Amanda Tozer’s patients can count on attentive and specialist care.

When a couple has successfully overcome the first stages of the IVF process, a failure at implantation can be devastating. For couples who have had repeated failures despite highly rated embryos, the chances of pregnancy may be improved by a process known as ‘endometrial scratching’. It has been shown in several randomised studies that this procedure of performing endometrial biopsies, usually during the luteal phase (after ovulation) of the menstrual cycle, can improve the rate of implantation, pregnancies and live births.

How does endometrial scratching work?

Endometrial scratching has been widely offered since 2003 but why it is effective is still not clearly known. The belief is that ‘injuries’ to the endometrium (the womb lining) stimulate the production of endometrial white blood cells, creating an inflammatory reaction that in turn enhances the uterus’s receptivity to implantation. Female gynaecologist Miss Amanda Tozer offers endometrial scratching at her London fertility clinic where it takes not more than 15 minutes. It can be uncomfortable and some women may find it painful; it is advisable to take analgesia such as ibuprofen an hour or two before the procedure – your doctor will advise you on this. It is also a good idea to bring a friend or your partner so they can escort you home afterwards.

How much does it cost?

If you are an existing patient of Miss Amanda Tozer, endometrial scratching will cost £100. The procedure is available to any patient, whether or not they are undertaking their IVF treatment with Miss Tozer; for these new patients, the price is £125. Miss Amanda Tozer is an experienced female gynaecologist who offers her London fertility patients expert and individualised support and guidance through this most difficult of challenges; she will talk you through the theories and practicalities of the procedure and its success rates, while ensuring you understand any associated risks or side effects.

Intracytoplasmic sperm injection (ICSI) is part of an in vitro fertilisation requiring only one sperm which is directly injected into the egg. As the sperm neither has to travel to the egg nor penetrate its outer layers, it can help many men with fertility problems conceive with their partners when other options are not open to them.

When will ICSI be recommended?

Your fertility consultant may suggest ICSI if fertilisation has failed in previous IVF cycles, or if the fertilisation rates have been poor with fewer than 25% of mature eggs being fertilised. It is also the preferred choice where the male sperm count is low, has a low number of normal forms or displays poor motility. ICSI is also an option if a man is unable to get an erection and/or ejaculate as the sperm can be taken from the epididymis or testicle under local anaesthetic using a fine needle.

What are the advantages and disadvantages of ICSI?

During a consultation with London female gynaecogist Miss Amanda Tozer, you will talk through all the pros and cons of ICSI. The primary advantage is that it gives some couples the best chance of conceiving a child where previously their only alternative might be a sperm donor. Another benefit is that sperm can be extracted if necessary; it is not at all uncommon for anxiety to prevent ejaculation on the day. In terms of disadvantages, the increased risks of multiple births and ectopic pregnancies are similar to those associated with standard IVF.

Another important consideration is the quality of the sperm: when a couple naturally conceive, only the strongest sperm make it through the egg’s outer layers.

At her London fertility clinic, Amanda Tozer will talk you through the associated risks and share the latest findings from on-going studies and advise you on pre-treatment screening for genetic problems.

For women who wish to delay having a child until their late thirties, be it for financial or social reasons, egg freezing is becoming an increasingly viable option.

How successful is egg freezing?

To improve the chances of the process being a successful one, a woman will ideally be under 35 years old when she freezes her eggs. While there are limited good studies that look at live birth rates from frozen eggs, what we do know is that approximately 90 per cent survive the process, and of those 70 per cent will fertilise, producing embryos.

The age of the woman at this stage remains an important factor as it does with any pregnancy: live birth rates from frozen eggs decline with age. In terms of potential risks, there are no increased risks in chromosomal abnormalities or development problems.

How does the process work?

Women attending female gynaecologist Miss Amanda Tozer’s London clinic will first have a pelvic ultrasound. This enables Miss Tozer not only to assess the accessibility of the ovaries, but also to check the antral follicle count, an indicator of remaining egg supply (the ovarian reserve).

The treatment of egg collection itself involves daily injections that stimulate the ovaries to produce more eggs; the level of stimulation will be adjusted according to your age and your ovarian reserve. Over the next fortnight, you will have two or three scans, before the eggs are collected on approximately days 14 to 16. Miss Tozer will perform the collection herself; the procedure takes around 30 minutes during which you will be sedated. You may experience mild bloating but this should settle within five days of the eggs being collected.

At Amanda Tozer’s London fertility clinic you will benefit from personal, one-to-one care with all aspects of the egg freezing process being explained, assessed and performed by Miss Tozer herself.

Any kind of fertility problem can cause friction in a relationship so it is completely normal for couples presenting at a fertility clinic already to be under some strain. It has also been found that IVF fertility treatment itself is a stressor and is the factor most likely to cause anxiety as the process unfolds. The role of stress during IVF treatment on the outcome has been of considerable interest with variable findings – but any means of easing this will certainly be welcomed by all.

Why is it so stressful?

The situation itself is extremely difficult. With couples longing to conceive, it is natural to oscillate between optimism that this cycle could be the one and then conviction that it is never going to happen. When you introduce hormones from the IVF drugs to the mix, everything becomes more intense. Further exacerbating factors can include a large, impersonal fertility clinic where you have minimal contact with your consultant, see different people for each procedure and don’t feel able to ask questions for fear of them being too trivial.

What can be done to make it less so?

At the Amanda Tozer London fertility clinic, you can be confident of receiving personal one-to-one, attentive and sympathetic care. Female gynaecologist Miss Tozer believes that continuity of care is hugely important and to this end she sees all couples prior to treatment to discuss their options and goes through the injections in detail, ensuring they know how and why to administer the drugs. She personally performs the egg collection, embryo transfer and first early pregnancy scan. Miss Tozer assures her London IVF patients that she can be contacted on her personal telephone at any time during the process, no matter how small the concern. Feedback from previous fertility patients shows that this personal care has been tremendously reassuring throughout what can be a nerve-wracking process.

Endometriosis is the second most common gynaecological condition in the UK affecting around one in 10 women. It is a chronic condition and the symptoms vary, often worsening with the menstrual cycle. Usually affecting women of reproductive age, one of its principal complications is a difficulty in getting pregnant.

What is endometriosis?

The endometrium is the lining of the womb. Endometriosis is a common condition where tissue that behaves like this lining is found elsewhere in the body, most commonly on the ovaries, on the lining of the pelvis and over the top of the vagina. Despite being outside of the womb, the cells of these patches of endometrium react the same way to the monthly cycle as the womb lining: by thickening in preparation for implantation, and then shedding if no fertilisation has occurred. However, with nowhere for this shed tissue to go, the result is often swelling and pain, usually in the lower abdomen or pelvic area. There is no known cure but symptoms are often managed by hormone therapy or medication. Endometriosis can sometimes damage the fallopian tubes or ovaries, thereby impeding a woman’s chances of pregnancy.

Can fertility treatment help?

Endometriosis is a common finding in patients presenting at Miss Amanda Tozer’s London fertility clinic. For women who have visible patches of endometriosis on their reproductive organs, surgery may be able to help. There is good evidence that the removal of these tissues can improve the chances of getting pregnant. During your initial consultation with highly experienced female gynaecologist Miss Tozer, you will discuss your full medical history and will undergo diagnostic tests and a pelvic ultrasound scan. Based in London’s Harley Street, Miss Amanda Tozer is accredited by the RCOG in Obstetric and Gynaecology, Subspecialist in Reproductive Medicine and Minimal Access Surgery, and well respected by her previous fertility patients for her support and attentive care.

Ovulation is a vital factor when a couple are planning a pregnancy. As the woman ovulates, she releases an egg that can then be fertilised by the sperm; fertilisation cannot occur until the egg is released. Some women do not ovulate regularly, and others do not ovulate at all. Female gynaecologist Miss Amanda Tozer treats many women at The London Clinic, helping them to regulate the ovulation process with ovulation induction, thereby increasing their chances of fertilisation.

What factors influence ovulation?

Stress, weight fluctuations and Polycystic Ovarian Syndrome (PCOS) are common factors in irregular ovulation. Among other issues, can also be caused by disorders of the thyroid or pituitary glands. During an initial consultation, Miss Amanda Tozer will take a full medical history, conduct a physical examination and run tests to inform her diagnosis; these will include an ultrasound of the ovaries and womb and blood tests.

How does ovulation induction work?

The purpose of ovulation induction is to stimulate the ovaries in order to produce a mature follicle and, in turn, egg growth, which creates a predictable window for intercourse. This is achieved most commonly by using Clomiphene, a mild fertility drug which comes in tablet form. Women take Clomiphene from day 2 to day 6 of a bleed and usually have a scan on day 10 to ensure that ovulation is going to occur and that the ovaries are not over-stimulated. If a woman does not respond to Clomiphene, daily injections of Gonadotrophins may be appropriate; in this case, scanning will be necessary to avoid over-stimulation of the ovaries.

Each woman responds differently to ovulation induction and therefore needs careful monitoring and attention. Amanda Tozer is a highly qualified female gynaecologist with many years’ experience of helping women with fertility problems. At Miss Tozer’s London clinic, you will receive individual care to guide you through this process.

The Daily Mail posted an article on 50 women who collectively had had 150 failed IVF treatment attempts till they were able to conceive. It was all down to a fertility treatment called Immunomodulation Therapy, costing around £7,000 a cycle. That’s around £2,000 more than conventional fertility treatment.

Immunomodulation Therapy works by flooding your bloodstreams with fatty acids which reduce the ability of the body’s NK cells to produce toxic chemicals.

These toxins can attack and reject the developing embryo as a foreign object.

The fats are about 200 calories a dose.

Administered via a drip usually twice before conception, and then three more times after, the treatment is thought to help the embryo implant and grow normally.

Alongside this, women are also recommended to take steroids, which further suppress the immune system, and blood thinners to prevent blood clots, which also can impede embryos implanting.

In an era of practising ‘evidence based medicine’, the beneficial use of Intralipids in IVF treatment is controversial, mainly because there are no large randomised controlled trials to look at its efficacy. This does not mean, of course, that intralipids should not be used and do not have any benefit. It is becoming ever more apparent that, in some women, their immune system may be the cause of failure of implantation, but it is trying to identify who those women are that is often the problem.

Indeed, whilst the identification of Natural Killer Cells either in blood or in the womb is possible, we do not know if abnormal NK cell levels cause implantation failure or not. However, when treating couples who have had repeated IVF cycle failures, I do not think that women should be denied the option of taking additional, unproven treatments, as long as those treatments do no harm.

The use of intralipids and steroids potentially have significant, if not proven, benefits with minimal risk. Whether or not the immunomodulation therapy resulted in the birth of the babies delivered, the stories are inspiring to those who may feel like their situation is hopeless. There are never any guarantees in IVF treatment, as many couples learn very quickly, and I believe it is not giving false hope but some hope.

Amanda Tozer
Consultant in Reproductive Medicine