10.4.20
Fertility problems

Extent: Jersey
Updated 22 June 2007
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General

Fertility problems and treatments - facts and figures (published in conjunction with 2006 -2007 Human Fertilisation and Embryology Authority (HFEA) Guide to Infertility - treatment and success data based on treatment carried out between 1 April 2003 and 32 March 2004).

It is estimated that one in seven UK couples have difficulty conceiving - approximately 3.5 million people. Although the majority of these will become pregnant naturally given time, a significant minority will not.

The National Institute for Clinical Excellence (NICE) define fertility as failing to get pregnant after two years of regular unprotected sex. Infertility is the commonest reason for women aged 20 - 45 to see their GP, after pregnancy itself.

1. Couples having fertility problems should firstly seek help from their GP.

2. GP assessment should involve:-

1. Medical history of both male and female (couples should approach their GP together).
2. Male semen analysis (two samples three months apart if the first result is sub-optimal).
3. Hormone assessment of the female's menstrual cycle.
4. Negative smear on the female taken within the past three years
5. Immunity status of the female to Rubella (German Measles) and Varicella (Chicken Pox).
6. Swabs taken from the female partner's vagina and cervix (neck of the womb) to exclude any underlying infection.

3. Following the above assessment, your GP will decide when it is appropriate to refer you as a couple to a consultant at the General Hospital, to be seen in the Assisted Reproduction Unit. Alternatively, couples may wish to be referred privately. There is a waiting list for appointments but once you have been seen for your initial appointment a plan of action will then take place over the following months.

What happens next?

4. Appointments for the Assisted Reproduction Unit are made as a couple. As fertility assessment involves both partners it is always recommended both male and female attend the appointment together.

5. Based on the history and results from your GP, it may be appropriate to commence treatment straight away.

6. Other couples may need more tests such as:-

1. checking that the female's fallopian tubes are open.
2. Ultra-sound scans to monitor the development of follicles (which should contain eggs) in the ovary.
3. Checking that the female is ovulating.
4. Further tests on semen.
5. Testicular ultra-sound tests.
6. Hormone testing of the male.
7. Genetic testing of either or both partners.
8. Testicular biopsy.
9. Tubal surgery on the female.

Treatments

7. The type of treatment offered will depend on whether a problem is identified. These treatments are covered by the public service and the only cost will be a prescription charge for any drugs prescribed and may cover:-

1. Basic cycle tracking with timed intercourse. This is the least invasive and monitors the follicles that develop in the ovary until ovulation of an egg.
2. If the female is not ovulating then tablets can firstly be given, the cycle will then be tracked and then timed intercourse is advised.
3. If the sperm is sub-optimal then this can be prepared in the lab and used for insemination with timed cycle tracking.
4. Sometimes it may be necessary to push the ovaries a bit more by using injections instead of tablets to stimulate them. Again this may then be followed by timed intercourse or insemination of sperm.

IVF (In-vitro Fertilisation) and advanced fertility treatments including ICSI (Intra-cytoplasmic Sperm Injection, Surgical sperm retrieval, Blastocyst Culture and Replacement, Pre-implantation Genetic Diagnosis (PGD/PGS selection ), Donor Sperm and Egg Donation Programmes.

8. Apart from Donor Sperm insemination all the above mentioned specialised treatments are carried out in conjunction with other units throughout the international community. Jersey mainly uses the Bourn Hall Clinic in Cambridgeshire, but for some of the more specialised treatments other units in the UK, America, Spain, Cyprus, Brussels, (in fact anywhere there are English speaking practitioners) may be used.

The HFEA Statistics show that the average success rate for IVF / ICSI treatment in the UK is:-

Over 42 years of age women should seriously consider using donor eggs. Eggs are from women under the age of 35, therefore success rates with donor eggs are as much as 28.2%.

The HFEA Statistics show that the average success rate for Donor Sperm Insemination treatment in the UK is:-

How much does it cost?

9. Jersey Health and Social Services Department has an agreement with Bourn Hall Clinic in Cambridge, for all couples having IVF and ICSI. This is called a satellite service which means that all the preparation, counselling, consenting, arranging and monitoring of treatment is done in Jersey. Routine IVF / ICSI means that couples will spend 5 days / 4 nights away for egg collection, embryology and embryo replacement. All the follow up is done in Jersey. The costs are as follows:-

Of these sums, £1,350 is payable to the Health and Social Services Department as a contribution to the treatment which includes staffing, laboratory and other costs including up to £1,000 for drugs per cycle. The balance is payable to Bourn Hall as follows:-

Couples will be invoiced by Bourn Hall for the amounts payable and are expected to make payment to Bourn Hall Clinic on the day of egg recovery at the centre.

Financial Assistance

10. The Health and Social Services Department will provide a limited number of treatments to couples at a reduced cost under the following additional criteria:-

1. The female partner should be no more than 36 years of age at the time of listing.
2. Couples must be childless with no living children from the current or any previous relationship.
3. Sub-fertility must not be due to the sterilisation of either partner
4. Up to three cycles may be funded at the reduced rate.

Provided the above criteria are met, couples earning less than £37,000 a year will be able to request treatment at reduced cost. In these circumstances the Department will not make a charge for the Jersey element of the treatment (£1,350), however, the couple will still be required to meet the charges levied by Bourn Hall.

In the event that the joint annual income is less than £31,000 per annum, the Department will also pay the £1,150 for IVF or £2,050 ICSI fee to Bourn Hall Clinic.

It should be noted that in both cases the Department may require proof of earnings.. The number of treatments available annually under these terms is restricted. A total of three treatments will be subsidised.

Patient Travel

11. Health and Social Services may provide assistance with travel. You will be given a copy of the policy at the time you are referred for treatment. All couples will still be expected to cover the costs of:-

1. General anaesthetic
2. Prescription charge from the pharmacy
3. Embryo storage and replacement
4. Any additional services such as Sperm Retrieval / Donor eggs / Donor sperm/ Blastocyst culture / assisted hatching.
5. Accommodation in Cambridge.

For further information please contact:-

Sister Michelle Thomas
Clinical Nurse Specialist and Fertility Services Co-ordinator
Assisted Reproduction Unit
Le Quesne Unit,
General Hospital

Further Information

12. There is no support group in Jersey at the present time. However there are UK based support networks that may provide help and information.

Human Fertilisation and Embryology Authority (HFEA)
www.hfea.gov.uk
020 7291 8200

Infertility Network UK (INUK)
www.infertilitynetworkuk.com
08701 188 088

British Infertility Counselling Association (BICA)
www.bica.net
01744 750 660

ACeBabes (Support for families following assisted conception)
www.acebabes.co.uk
0845 838 1593

UK Donorlink
www.ukdonorlink.org.uk
0113 278 3217