Brochure 2014/15 www.fertility-academy.co.uk
The Fertility & Gynaecology Academy
Introduction The Fertility & Gynaecology Academy — London’s leading fertility clinic for infertility treatments The Fertility & Gynaecology Academy is an established Assisted Established in 2004, it is a progressive clinic consisting of a highly dedicated team, experienced in the treatment of male and female fertility problems. services including gynaecology, pelvic ultrasound and endoscopic surgery. We run the most comprehensive Reproductive Immunology Programme in UK if not in Europe, including uterine NK cells, LIT, KIR test, G-CSF therapy, etc. We recognise that undertaking infertility diagnosis and treatment can be extremely stressful due to the inherent emotions and financial cost techniques available in Assisted Conception, but also personalised direct support from our consultants. We ensure that every patient feels educated, comfortable and fully supported throughout their treatment. package at an extremely competitive price. All this coupled with consistently high success rates, especially for women with complex fertility problems, makes us an ideal choice for women and couples seeking to start a family via assisted conception. Please note that currently all fertility treatments that require a license by the HFEA (including IVF, ICSI, IUI, donor insemination, storage of gametes or embryos) are carried out by Dr A Gorgy at, Boston Place Clinic, 20 Boston Place, London, NW1 6ER..
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Brochure 2014/15
Our Consultants DR A Gorgy, Fertility Consultant & Co-Director MBChB, MSc, FRCOG
Dr Gorgy has been practising in the field of Fertility and Assisted Conception since 1994. He founded The Fertility & Gynaecology Academy in 2004 with Dr Eskander and is co-director. He was the Clinical Director of the London Fertility and Gynaecology Centre for over four years. Here he created all the clinical protocols for the unit. He contributed to the development and improvement of new techniques e.g. Micro-surgical Sperm Retrieval (PESA and TESA), Assisted Hatching and Blastocyst Transfer. Through hard work and dedication to his patients, he improved and maintained good results of the unit during his directorship. He was then approached by the Assisted Reproduction and Gynaecology Centre (ARGC) to work as a Consultant Gynaecologist and Deputy Director from 2000 to 2005. In this role he contributed to the outstanding results of the unit and to the introduction of new developments, including Pre-Implantation Genetic Diagnosis (PGD), Reproductive Immunology and egg freezing. Dr Gorgy also worked alongside late Dr Alan Beer, when he treated patients with Reproductive Immunology problems in the UK. Dr Gorgy’s name is mentioned as an Associate with the Beer’s Institute in Dr Beer’s famous book Is Your Body Baby-Friendly? During his career, he also set up a very successful Assisted Conception Unit at Alsalam Hospital, a prestigious hospital in Cairo. He is still very committed to this unit in a consultancy and professional advisory capacity. Dr Gorgy is an active member of the European Society of Reproductive Immunology (ESRI) and is well connected to the American Society of Reproductive Immunology (ASRI) and International Society for Immunology for Reproduction (ISIR). Dr Gorgy is today one of the most respected fertility consultants in the UK. Working from The Fertility & Gynaecology Academy, he consistently forms a close and meaningful bond with all his patients as a result of his empathetic, non-judgemental and compassionate approach towards each individual case. Over the years, Dr Gorgy has dealt with patients from all corners of the world, allowing him to understand and meet the needs of patients with varied cultures, customs and backgrounds.
DR A Eskander, Consultant Gynaecologist & Co-Director MBChB, FRCOG
Dr Eskander is a well known leading gynaecologist with a special interest in the field of assisted conception. Along side Dr Gorgy, he is the co-founder and co-director of The Fertility & Gynaecology Academy. Dr Eskander complements Dr Gorgy by providing a one-stop gynaecology care service for women. He is able to utilise his wealth of experience to diagnose and treat women for all kinds was admitted as a distinguished Member of the Royal College of Obstetrician and Gynaecologists in 1977, and by 1983 he was acknowledged as one of the few obstetricians and gynaecologists in the world who could make an accurate and confident diagnosis of fetal abnormalities and gynecological problems using ultrasound. In 1989 he moved overseas to help organise the obstetric unit at the prestigious teaching hospital in Bahrain, one of the first hospitals in the middle east to introduce IVF. Since returning to the UK in 1993, Dr Eskander has gained a reputation as one of the pre-eminent gynaecologists working in London. He has had a special interest in Assisted Reproduction since 1989 and in immunology since 2010. He has used Saline Installation Hysterography (SIS), or Aqua Scan for evaluation of the uterine cavity since 1995. Dr Eskander is also a consultant in the field of assisted conception. He has recently been awarded a mini fellowship in Reproductive Immunology from Rosalind Franklin University in Chicago, USA.
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The Fertility & Gynaecology Academy
Infertility Treatments The Fertility & Gynaecology comprehensive set of treatments for male and female infertility problems. Our consultants will thoroughly investigate your circumstances and medical history before advising you on the most appropriate fertility treatment. A list of some of the treatments Gynaecology Academy is provided here.
Starting a family is one of the biggest decisions we make in life, yet having a baby isn’t always easy. As one of the UK’s leading centres for fertility diagnosis, support and treatment, The Fertility & Gynaecology Academy is dedicated to giving you the best possible chance of having a baby. Your fertility specialist will investigate all possible causes of infertility before any treatment begins. These investigations will include compiling a medical history for you and your partner, hormone tests for the woman (including ovarian reserve) and sperm tests for the man. We then take you through all possible treatment options and outline the one best suited for you. throughout the entire process, thereby ensuring that all treatments are carried out to the highest professional standards.
IVF / ICSI / PICSI Two of the most widely known treatments for male and female infertility are In-Vitro Fertilisation (IVF) and Intra-cytoplasmic Sperm Injection (ICSI). At the Fertility & Gynaecology Academy, we have the experience of using both these procedures successfully to help couples achieve conception, and have consistently achieved impressive results. The aim of an IVF cycle is to produce several eggs which are collected and fertilized in the laboratory. The best embryos are then selected and returned to the uterus. There are various protocols used, some of which start with the administration of drugs to ‘down-regulate’ your own hormones (and to prevent ovulation). FSH (and sometimes LH) hormone is then administered by daily injections to stimulate your ovaries to produce a number of eggs. Frequent ultrasound scans and blood tests are needed during stimulation to monitor your response and to tailor your treatment to produce the optimum number and quality of eggs. The stimulation part of the treatment usually takes 8-14 days. At the optimum time, you will be instructed to discontinue the stimulation drugs and to inject a ‘trigger’ medication which ‘ripens’ the eggs (HCG). 36 hours later, the eggs are recovered from your ovaries under light sedation using a fine needle that is passed through the wall of the vagina into the ovary using ultrasound guidance. Your partner will provide a sample of sperm to fertilise the eggs. When you have recovered from the sedation you will be able to return home accompanied by an escort (but will not be permitted to drive for 24 hours). The fertilisation of the eggs and the development of the embryos will be monitored by the embryologist to advise on the best day to return the embryos to your uterus. This to have a maximum of 2 embryos transferred under the HFEA rules. Women over 40 are permitted to receive a maximum of 3 embryos. Decisions on whether to limit the transfer to 1 embryo are taken on the basis of the patient’s preferences and on our assessment of the likelihood of multiple pregnancy for that particular patient. The treatments described are mainly for information purposes and should not be considered a substitute for medical advice.
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Brochure 2014/15
Embryo Transfer usually requires no sedation and is performed by passing the embryos through the cervix up into the uterus using a narrow catheter. You will be able to go home as soon as you feel ready. Excess good quality embryos can be vitrified (frozen) for a subsequent transfer, but not all embryos will merit freezing as only good quality embryos are likely to survive the defrosting process and give a reasonable chance of pregnancy. Frozen embryos can usually be stored for up to 10 years (55 years in specific circumstances). There will be an additional charge for vitrification and an annual storage charge. In conventional IVF, a large number of sperm are placed with each egg, so that the sperm compete ‘naturally’ to fertilise the egg. In ICSI-IVF, individual sperm are selected by the embryologist and injected into each egg. ICSI may be the only option where sperm numbers or quality are sub-optimal, but it may also be suggested in other circumstances e.g., where antisperm antibodies, thickened zona (shells of the egg) or other factors are likely to cause failure to fertilise without ICSI. PICSI is a method of selecting the best possible sperm for fertilisation in the IVF protocol. Please visit our website for more information on IVF, ICSI and PICSI.
Ovulation Induction
With this technique, monitoring of the natural cycle is undertaken through hormone assessments and ultrasound scans, which may be advantageous in helping couples to identify the optimal time of intercourse, giving the highest chance of natural conception. If ovulation is not occurring, medications such as clomid or other fertility drugs are administered, to stimulate the follicles in the ovaries, resulting in the production of multiple eggs. Alternatively, a low dose of FSH may be used. Fertility drugs are available in both tablet and injection forms and are normally given within the first few days of the cycle, with an injection of HCG when the follicle is mature. The medications also control the time you will release the eggs, enabling the scheduling of sexual intercourse, IUI (Intrauterine Insemination) or IVF procedures at the optimal time to achieve pregnancy. It is recommended that you take folic acids and vitamins to improve your nutritional intake status, and reduce the risk of neural tube defects as with natural pregnancy.
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Time Lapse Imaging (Embryoscope)
The Fertility & Gynaecology Academy
Genetic Testing
Frozen Embryo Replacement (FER)
Egg Freezing & Sperm Freezing
Egg Donation & Egg Sharing Programme
Surrogacy
Intrauterine Insemination (IUI)
For more information on all Infertility Treatments, please refer to our website. Surgical Sperm Aspiration (PESA / TESA)
Blastocyst Transfer
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Brochure 2014/15
Recurrent IVF Failure & Recurrent Miscarriage If you are trying to conceive and have experienced recurrent IVF failure or worse, recurrent miscarriage, it can be a frightening and emotionally draining experience. At The Fertility & Gynaecology Academy we understand the frustration of couples who have experienced repeated IVF failure and have not been able to find out why it has happened isolate the problems causing implantation failure, or preventing you from successfully carrying a baby to term. These tests can be broadly grouped into four categories: Immune Testing for Infertility There is currently much on-going debate in the scientific community about the role of the immune system in promoting or preventing a healthy pregnancy. There is a view pioneered by late Dr Alan Beer that the products of an activated immune system could damage the placenta and cause miscarriage, as well as damage the embryo and cause implantation failure. Natural killer cells, which help to keep the body from developing cancer, can overpopulate the uterus or exist at too high levels within the blood stream. These cells then go overboard, killing the embryo or interfering with the endocrine system that produces the hormones that are essential for pregnancy.
At The Fertility & Gynaecology Academy we carry out a comprehensive group of tests system and related thrombophilia. These include testing for: Antibodies, Natural Killer Cell Assay, TH1/TH2 Intracellular Cytokine Ratio, Leukocyte Antibody Detection (LAD) or Paternal Leukocyte Antibodies (PLA), DQa genes, Killer-cells Immunoglobulin-like Receptors (KIR), clotting factors and Gene Mutation of Factor II, Factor V and MTHFR. Once we have identified the problem, we can provide relevant supportive immune therapy: Steroids, Clexane, IVIg, Intralipids, Lymphocyte Immune Therapy (LIT) and G-CSF (Neupogen). Infection Screening Infections particularly Chlamydia, mycoplasma and ureaplasma can last and recur for years. Such infections make it unsuitable for the embryos to implant or the pregnancy to continue. They can also agitate your immune system and make it over-reactive i.e. increase your natural cell and other immune components activity. The latter will make the environment in you uterus hostile for the embryos and the pregnancy. We undertake screening tests for infections via a vaginal treatment.
Uterine Cavity Assessment Implantation failure or miscarriage can happen because of an abnormality in the uterine cavity e.g. polyps, adhesions, scar tissue or maybe even a septum you were born with. Even minor abnormalities can cause problems and dealing with them would improve your chances of success. We can explore the uterine cavity by saline hysterography; also known as Saline Installation Sonography (SIS) or Aqua Scan, and if any such abnormalities are found, perform a hysteroscopy for its treatment. Karyotyping We check the chromosome set of both partners to exclude the possibility of underlying chromosomal rearrangement problems. If this is identified, we can test the embryos and only select the normal ones for transfer. You can read more about the tests outlined here on our website. While there are no guarantees, if you are ready to ask for assistance, we believe that at The Fertility & Gynaecology Academy we can improve your chances of a successful pregnancy. Our experience, close monitoring of the patients and personalised treatment can give you the extra help you need to safely navigate the obstacles keeping you from your dream of having a baby.
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The Fertility & Gynaecology Academy
Success Rates Having decided you wish to proceed with assisted conception, choosing a clinic can be a success rates. diagnoses various clinics treat and so on), they can be a useful tool in deciding if you want to proceed further with a clinic. Here at The Fertility & Gynaecology Academy, our success rates are among the very highest in Britain. Indeed, our positive pregnancy rate for women under 35 in 2013 was 62%, for all ages 50%. We are particularly proud of this figure considering that our specialism is treating complex cases of recurrent IVF failure (IVF treatment that has been repeatedly unsuccessful at other clinics for whatever reason). We have provided a table of recent success rates below. Since fertility declines with age, we have divided the information into appropriate age brackets. Fresh IVF/ICSI own eggs per embryo transfer 2013 Age
<35 yrs
35-37
38-39
40-42
43-44
≥45
Total
Clinical Pregnancy Rates
52.04%
36.36%
38.24%
32.43%
17.65%
50.00%
41.45%
Egg Donation per Embryo Transfer (ET) 2013.
All Patients 60%
Frozen Embryo Transfer (FET) cycles 2013 Age
<35 yrs
35-37
38-39
40-42
43-44
≥45
Total
47.62%
60.00%
33.33%
33.33%
0.00%
100%
47.54%
Intrauterine Insemination Husband Age
<35 yrs
35-37
38-39
40-42
43-44
≥45
Total
10.00%
20.00%
50.00%
0.00%
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-
16.67%
For the time being The Fertility Academy uses City Fertility and Boston Place facilities for its HFEA licensed procedures (including IVF, ICSI, IUI, donor insemination, storage of gametes or embryos) and the tables above represent the overall City Fertility results as requested and validated by the HFEA. pport from our specialists. Our consultants are leaders in their field and they will always ensure that you feel educated, comfortable and fully supported throughout your treatment with us. 8
Brochure 2014/15
How Fertile Am I? patients a comprehensive Fertility Check to make sure all is well. For one upfront fee, you will receive a comprehensive assessment of your fertility potential, and, if any potential stumbling blocks are discovered, we’ll guide you around the next steps. Women’s Fertility Check 1.
In an Initial Consultation with one of our esteemed fertility experts, we’ll talk you through the whole series of necessary tests, through which you’ll have an expert consultant as your port of call. You’ll also have the chance to have your questions answered.
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A Transvaginal Ultrasound Scan is an important means of checking for any possible causes of infertility. It is a pain free procedure that looks at the female reproductive system and is a common test for women experiencing problems getting pregnant. The scan involves assessment of the uterus, ovaries and fallopian tubes, and is a more accurate means of making these assessments than an abdominal ultrasound. It does not require a full bladder.
3.
Saline Hysterography, also called Saline Installation Sonography (SIS) or Aqua Scan: for integrity of uterine cavity and patency of the tubes. In this investigation, a sterile saline is placed into the uterine cavity through a fine catheter. The integrity of the uterine cavity is then examined by
an ultrasound scan. Implantation failure or miscarriage can sometimes happen due to blocked fallopian tubes filled with potentially infectious fluid (Hydrosalpinx), or uterine abnormalities. such as polyps, adhesions or scar tissue, or even a septum that you were born with. An Aqua Scan provides a better visualisation of the uterine cavity and fallopian tubes for potential obstructions. 4.
The AMH blood test measures your levels of a hormone known as the Anti-Mullerian Hormone. This hormone is produced by follicles in the ovaries and levels of AMH are associated with a woman’s ‘ovarian reserve’. Generally as a woman ages her levels of AMH decline, reaching undetectable levels in post-menopausal women. Therefore AMH levels reflect the function of the ovaries and so generally, the lower your AMH levels, the lower your ovarian reserve is taken to be. The AMH test can be done at any time of the cycle. The level is fairly consistent regardless the time of the cycle and in
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A Consultation to explain the results follows. Here at the Academy we take the proper time and care to ensure that you are informed and fully understand the implications of any test results. You will have the opportunity to ask any questions and receive comprehensive answers in plain English so you’re never kept in the dark.
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A detailed written report with a conclusion and advice is provided, presenting all our findings and recommendations. It is important that you come out of this process not only with a good sense of what may be causing any problems with conception, but what can be done about it. Our experts are among the best in their field, you can rest assured you’ll leave with advice you can trust. Having a report in writing also enables you and your partner to revisit this detailed information as many times as you need to, as you consider your options.
Couple’s Fertility Check Male problems account for around half of all infertility issues and may include: Abnormal sperm, lack of sperm itself or low sperm count, low semen volume, problems with sperm motility, increased semen viscosity, genital tract infection, or simply a natural decline in fertility. The Couple’s Fertility Check includes all the female investigations and reports as detailed above, with the addition of a semen analysis investigation. assessed to establish the mobility and shape, as well as the number of sperm and overall content of the seminal fluid. These packages should be booked ahead and paid for in advance. A Fertility Check can help you and your partner achieve clarity as to where you are in your journey towards conception, as well as straight answers as to what, if anything, needs to be done to help you along. Here at The Fertility and Gynaecology Academy, we have years of experience in helping couples to create the family they’ve always dreamed of.
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The Fertility & Gynaecology Academy
Fees CONSULTATIONS AND ULTRASOUND •
Initial consultation Up to 45 min with a qualified consultant and fertility specialist. This involves full history, possible diagnosis and treatment plan.
£210
•
Follow-up consultation To discuss test results, their implications and possible treatment plan.
£160
• • • • •
Initial telephone consultation Follow up telephone consultation Nurse consultation during the treatment Follow up consultation following unsuccessful treatment cycle (within 1 month) Baseline ultrasound By consultants, necessary and important for all new patients. Allows assessment of the uterine cavity to exclude developmental abnormality, fibroids and polyps. It also permits assessment of the ovaries and ovarian egg reserves.
£210 £160 Free Free £180
•
Saline sonohysterography/ HyCoSy/ Aqua scan Injecting saline into the uterine cavity to exclude abnormalities, fibroids and polyps and a tube test if necessary.
£420
•
Gynaecological ultrasound by consultant
£180
Obstetric ultrasound: • Early for Dating and viability • Fetal anomaly scan, 18-20 weeks • Fetal sex scan (between 12 and 16 weeks with 98% accuracy) •
£180 £320 £600 £240
FERTILITY TREATMENTS •
Intrauterine insemination Includes ultrasounds, consultations during the treatment cycle, and laboratory sperm preparation and intrauterine inseminations
£850
•
IVF (in vitro fertilisation) Includes consultation and ultrasound during the treatment cycle, egg collection, surgeon fees and embryo transfer. It does not include the price of drugs, blood tests and sedation. ICSI surcharge
£3,000
£1,000
• •
IVF / ICSI (intracytoplasmic sperm injection) All inclusive package IVF / ICSI The following conditions apply: The patient should be less than 35 years old and have an optimum AMH. This should be her first IVF cycle or she should not have any previous unsuccessful cycles. The package does not include initial consultation, scan, mock ET or any other initial investigation costs. Extended in-vitro culture of embryos to day, embryo freezing and storage will incur extra cost.
£4,000 £5,250
•
Egg freezing treatment cycle by vitrification excluding drugs, blood tests, HFEA fees and storage, and ICSI using frozen eggs
£2,750
• • • • • • • •
ICSI using frozen eggs HFEA fees for IVF cycle Cancelled IVF cycle Sedation for any procedure if necessary Specialized semen analysis + MAR test Specialized semen analysis + MAR test + Sperm survival assessment over 24 hours Surgical sperm retrieval PESA / TESA (including local anesthesia or IV sedation) Cycle monitoring or timed sexual intercourse
£2,500 £75 up to £800 £250 £175 £225 £1,250 £550
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Brochure 2014/15
TEST • • • • • • • • •
Cx Smear test Chlamydia in menstrual blood by PCR Chlamydia and ghonorhea tests (cx swab/urine/semen) AMH Chlamydia, Mycoplasma and Ureaplasma in menstrual blood by PCR test for DNA 18 microorganisms in menstrual blood including Chlamydia, Mycoplasma and Ureaplasma by PCR test for DNA Female Fertility Assessment (Ultrasound ovarian reserve and AMH) Women’s Fertility Check (Consultation, Scan, Saline Hysterography, AMH & FU Consultation) Couple’s Fertility Check (Consultation, Scan, Saline Hysterography, AMH, Semen Analysis & FU Consultation)
£120 £200 £80 £120 £400 £500 £350 £650 £800
EMBRYOLOGY
• • • • • • • • • • •
Time Lapse Imaging (Embryoscope) PICSI Assisted hatching Extend in vitro culture to day 5 and blastocyst transfer Frozen embryo transfer treatment cycle Embryology Freezing (including one year storage) Semen freezing Annual storage fee for sperm, eggs or embryos (paid directly to the IVF Lab) Donor sperm (depends on type & availability) HFEA fee for donor sperm IUI PGS (Preimplantation Genetic Screening) by CGH not including blaAstocyst culture
£450 £250 £450 £450 £1,200 £600 £250 £300 up to £1,000 £37.50 £2,000 £450*
•
PGD (Preimplantation Genetic Diagnosis) pretest work up fee
£2,200
•
PGD (Preimplantation Genetic Diagnosis) testing fee Including blastocyst culture
£2,100 £450*
IMMUNE TESTING • • • • • • • • • •
Natural killer cells panel screen TH1/TH2 intracellular cytokine ratios Natural killer cells panel TH1/TH2 intracellular cytokine ratios Natural killer follow-up Leukocyte antibody detection (or paternal leucocyte antibodies, blood sample from both partners) Gene mutation test for factor II and V, MTHFR α Killer Cell Immunoglobuline-like Receptors (KIRs) Endometrial Biopsy for NK cells Thrombophilia (comprehensive including gene mutation for clotting factors)
£480 £370 £775 £400 £220 £250 £220 £220 £475 £550
IMMUNE THERAPY • • •
IVIG 25 Gms (IV drip) IVIg 30 Gms (IV drip) Intralipid 20% 100 ml (IV drip)
£1,450 £1,700 £275
N.B. For the latest prices please refer to the website: www.fertility-academy.co.uk
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Appointments and enquiries The Fertility & Gynaecology Academy 57A Wimpole Street London W1G 8YP Phone: 020 7224 1880 Fax: 020 7224 1550 E-mail: info@fertility-academy.co.uk Website: www.fertility-academy.co.uk All appointments must be booked and confirmed by phone. Opening hours Monday to Friday: 8am to 6pm Saturday: 8am to 12pm
Getting to our clinic Our clinic is within easy walking distance of Regentâ&#x20AC;&#x2122;s Park, Oxford Circus, Great Portland Street, Bond Street and Baker Street underground stations. On street car parking is available in Wimpole St and the surrounding area and is payable by credit card using the phone numbers displayed on signs.