What I’ve Learnt: Fertility Clinic

I recently got to spend some time with the Fertility Nurse Specialists at my local fertility clinic, sitting in on patient appointments and getting to see lots of ultrasounds. The nurses were also able to provide me with loads of extra information and reading material, all of which I’ve included below.

Lap and dye

A medical procedure in which dye is injected into the fallopian tubes while the patient is under an anaesthetic. This dye is radio-opaque and can allow the fallopian tubes to be clearly visualised under x-ray, so that any issues with them can be identified, eg blockages. The laparoscopy also allows the surgeon to visualise any other potential issues, such as fibroids, endometriosis or cysts.

Hysterosalpingogram

The less invasive version of the lap and dye. Dye is still injected into the fallopian tubes and x-rays taken, but there is no laparoscopy.

Ovarian Hyperstimulation Syndrome (OHSS)

This is typically caused by fertility medication that aims to induce follicle production in the ovaries ready for insemination or oocyte retrieval. In rare cases, the dose of medication can be too much for some people, resulting in swelling of the ovaries, being generally unwell, rapid weight gain, nausea and vomiting.

Haematocrit

A measurement of the proportion of blood that is made up of cells. This is a vital measurement for patients with OHSS as there is a clear correlation between its severity and the patient’s haematocrit.

Follicles

For patients undergoing fertility treatment, they will often come in at the beginning-middle of their cycle to have the size of their follicles assessed. This gives the practitioner a good idea of whether they are likely to ovulate and when it will happen.

Number of follicles

The number of follicles is also significant, as too few and the patient is less likely to ovulate. However, if there are too many, then the risk of multiple pregnancies can be too high and the fertility plan must be re-evaluated.

Schedules

Once the practitioner has a good idea of the patient’s cycle, they can provide them with the schedule on when to take certain medications depending on their treatment and when the optimum time for intercourse is, to improve their chances on conception.

Hormones and drugs

There are a number of medications available to patients.

Clomifene citrate – this induces gonadotropin release from the hypothalamus and is used to induce ovulation

Tamoxifen – an alternative to clomifene. This also blocks oestrogen and stimulated gonadotropin.

Metformin – can be used in the treatment of polycystic ovary syndrome (PCOS) off license, as they are often affected by insulin resistance. Reducing their blood sugars can help improve fertility.

Synthetic Human Chorionic Gonadotropin (hCG) – a synthetic version of the normal sex hormone and stimulated ovulation.

Follicle Stimulating Hormone (FSH) – does what it says on the tin.

Intrauterine insemination (IUI)

Procedure is where sperm is manually placed in the uterus for insemination.

Invitro fertilisation (IVF)

Eggs are collected and fertilised with sperm in a lab – the resulting embryos are then placed back into the uterus.  

Embryo transfers

Literally the transfer of embryo’s out of the lab, where the eggs and sperm were previously introduced, and into the uterus.

Intracytoplasmic sperm injection (ICSI)

This is the next step up from IVF and involves injecting the important bits of the sperm into the cytoplasm of the egg. Most commonly used in cases of male infertility where there is something wrong with the sperm, preventing them from fertilising the egg as they normally would. Can also be used during genetic testing as this cannot be done when there’s a sperm dangling off the side of an egg.

Human Fertilisation and Embryology Authority (HFEA)

The UK’s independent governing body over all thing’s fertility. They provide the licences and monitor facilities, ensuring a high standard of care is maintained. HFEA also publish research and information for both patients and healthcare professionals.

Embryologist

Someone who gets to play with eggs, sperm and embryos in a lab. They’re typically involved in every stage of fertility treatment, from determining whether a patient is infertile, what the specific issue is, egg and sperm collection, sorting or freezing, fertilisation and insemination.

Fibroids

Small, benign tumours on the walls of the uterus.

So what?

Fertility treatment is a real niche area of healthcare, but this doesn’t mean nurses shouldn’t have at least a little bit of knowledge about its existence and what goes on. There’s always the chance that a patient undergoing fertility treatment is admitted to your ward for something completely different and they’d really appreciate someone knowing something about that side of their care.

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