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.

Polycystic ovarian syndrome (PCOS) is a very common menstrual disorder affecting around 1 in 10 women. It is diagnosed when a woman has two of the three following symptoms: ovaries with many small cysts, a raised level of the male hormone testosterone and irregular periods.

Why is my fertility affected?

The exact cause of polycystic ovarian syndrome is not known; several factors are likely to be involved including insulin resistance and a high level of luteinising hormone. What is known is that one symptom is the abnormal development of the follicles in the ovaries: they often fail to develop fully, causing problems with ovulation and therefore irregular periods. Ovulation is essential to the conception process: a reduction in periods tends to result in reduced fertility.

What are my treatment options?

Polycystic ovarian syndrome is often associated with being overweight or obese. If this is the case, then the first step is to lose weight as this can significantly improve your chances of regular menstruation. After this point, you may be a suitable candidate for fertility treatment or, in some cases, surgical intervention.

During a consultation at the London Clinic, female gynaecologist Miss Amanda Tozer will take your full medical history before conducting a pelvic ultrasound and running blood tests. Diagnosing your individual case, Miss Tozer will then advise you on the most appropriate treatment. Many women with polycystic ovarian syndrome respond well to fertility drugs such as Clomiphene whereby a more predictable window for conception is created by inducing ovulation.

Miss Tozer is a Consultant Gynaecologist and Sub-Specialist in Reproductive Medicine. She has treated the whole spectrum of menstrual disorders, helping many women to achieve the family they desire. Testimonials from her previous patients in London credit her for her attentive, personal and encouraging care.

There is not a ‘cure’ or treatment for the menopause itself, but there are treatments for its symptoms, one of which is Hormone Replacement Therapy. HRT has provided effective relief for many women over years but the associated risks and side effects have attracted critics.

During a consultation at the London Clinic with female gynaecologist Amanda Tozer, you will have the opportunity to discuss the pros and cons of HRT, and to find out about the potential risks and side effects. Miss Tozer has helped many women manage their menopausal symptoms using HRT and is well placed to give you all the facts and advice you need in order to make an informed decision about your treatment.

What does HRT do?

Hormone Replacement Therapy contains an oestrogen hormone that replaces the oestrogen your post-menopausal ovaries have ceased to produce. Oestrogen on its own, however, would result in the building up of the womb lining, increasing a risk of cancer of the uterus. For this reason, HRT usually combines the oestrogen with a progestogen hormone that drastically reduces the risk of cancer. The different types of HRT contain a varying degree of each hormone; some women need to try a few combinations before finding the one that works for them.

What are the side effects of HRT?

Both oestrogen and progestogen produce different side effects with some crossover. Possible side effects include fluid retention, breast tenderness, leg cramps, headaches, indigestion, acne, backache, depression and nausea.

Before embarking on any course of treatment, London based gynaecologist Miss Tozer will explain the potential side effects – as well as how the worst of these may be relieved by a number of lifestyle changes. With her years of experience in treating the symptoms of the menopause, she can help you put the risks and side effects of HRT into a useful perspective.

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.

The good news is that awareness of female diseases such as breast and cervical cancer has increased, with more women being vigilant with their health. However, the reality is that most women’s lifestyles are too busy to accommodate much more than a cursory self-check and attendance of routine screening appointments. Whether a woman is in her reproductive or menopausal years, a check-up at a Well Woman clinic can be invaluable, either providing early diagnosis or indicators about required changes in lifestyle.

What will I be screened for at the Well Woman Clinic?

There are frequent developments in screening technology, and tests can detect early signs of female cancers – breast, uterine, ovarian and cervical – and non-cancerous illnesses including osteoporosis, heart disease and diabetes.

At female gynaecologist Miss Amanda Tozer’s London clinic, a full medical history will be taken before the following tests are run: full blood count, liver and renal function, fasting glucose and cholesterol levels, body mass index, blood pressure, urinalysis, breast examination and cervical smear.

Miss Tozer can also run hormone tests to check ovarian and pituitary function and conduct a gynaecological pelvic ultrasound to assess the pelvis for abnormalities such as endometrial polyps, uterine fibroids and ovarian and para-ovarian cysts. There is also the option of a CA125 test; rather than a diagnostic test, a CA125 can be used to monitor high-risk women with a family history of ovarian cancer.

Can you screen for osteoporosis?

Osteoporosis is relatively common, affecting around 3 million people in the UK to some degree. It usually, but not exclusively, affects post-menopausal women. Miss Amanda Tozer offers bone densitometry tests to women attending her London Well Woman Screening clinic. This test involves performing a scan of the hip and spine to assess bone density, detecting the presence of bone loss, be it mild or severe.

To find out more, call 020 7034 6240 or click here. Here’s a link to clinic times at Miss Tozer’s Well Woman Clinic.

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.

The average age for a woman in the UK to start the menopause is 52 but, as many women start experiencing symptoms before they reach 40, this figure does not give a true indication of when it is likely to happen to you. And just as the menopausal age has a vast range, so does the list of possible signs, and the degree to which you will suffer – if at all.

What are the symptoms of the menopause?

Often, one of the first signs is a change to your menstrual cycle, with your periods getting lighter or heavier, or more or less frequent. Many women report a loss of libido and vaginal dryness that can make sex uncomfortable or even painful. Hot flushes are a very common symptom; the feeling that your body is burning is usually more pronounced over the chest area and the head. Much research has been done on hot flushes but as yet there are no conclusive explanations. Other symptoms include headaches, heart palpitations, insomnia and mood changes. These symptoms usually, but not always, clear once the menopause is behind you; by seeking the advice of an expert such as London female gynaecologist Miss Amanda Tozer, you give yourself the best chance of dealing effectively with everything the menopause throws at you.

Is there a cure?

There is no cure for the menopause itself but it is possible to treat most of the symptoms with medication and hormone replacement therapy. The menopause can be both physically and emotionally challenging for some women and it is important that they are supported through this difficult time. At Miss Amanda Tozer’s menopause clinic in London’s Harley Street, menopausal women can get the help they need to manage the side effects. An experienced female gynaecologist, Miss Tozer has helped hundreds of women through their menopause, offering effective treatments and sound advice and support.

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.