Assisted Conception Services
Nuffield Health Woking Hospital
Centre no: 0144
PATIENT INFORMATION LEAFLET
MANIPULATED FROZEN EMBRYO REPLACEMENT CYCLE
General Health and Diet
PRIOR TO TREATMENT
SMOKING
Smoking can be dangerous during pregnancy and can also decrease your chance of conceiving.
Therefore it is imperative that neither of you smoke.
ALCOHOL
Alcohol should be kept to a minimum (less than 5 units per week) for both partners.
CAFFEINE
Caffeine intake should be reduced. Caffeine can be present in coffee, tea, cola and chocolate.
DIET
A healthy eating plan we believe to be helpful is to avoid snacking between meals (including
‘healthy’ snacks i.e. fruit, muesli bars, fruit juices and smoothies). If you want to eat these
types of foods add them into one of your 3 meals a day. Meals should always have some protein
content i.e. fish, eggs, meat, cheese or pulses. Try to keep the carbohydrate content in each
of your meals lower than the amount of protein e.g. Instead of a large bowl of pasta with small
amount of protein, change and have a portion of meat or fish with small side helping of pasta
or rice or potatoes.
We also advise that you avoid soft cheese, pate, liver, sword fish and shell-fish from the day of
treatment
FOLIC ACID
You should take folic acid 400 micrograms daily from 3 months before the scheduled treatment
cycle. This is a Department of Health advice for all women wishing to conceive and not just for
assisted conception treatment. This vitamin has been shown to reduce the chance of spina
bifida and is available from chemists. You should continue with it for as long as you are trying
to conceive and for the first three months of pregnancy. Also it is good advice to eat a
balanced diet with plenty of vegetables and raw fruit. We would recommend taking folic acid
combined in with a multivitamin product specific to pregnancy.
WEIGHT
Normal body weight for both partners will increase your chances of success. We will work out
your body mass index for you and advise you whether you should lose weight. Equally a low
body mass index can also reduce success. There are individual situations when it may not be
possible to start treatment until there is a weight reduction.
SCREENING
We will need hard copies of the results of various tests to be in place and in date before you
can commence treatment. A list of those will have been sent to you with your initial
consultation documentation. They need to be repeated annually. Your GP may possibly help
with screening but if this is not possible, we can arrange all your screening to be done here.
FLUID INTAKE
We advise all women to drink 2 litres of water from the beginning of the period in which they
are commencing treatment.
Assisted Conception Services
Pt information leaflet – FET Manipulated
Version 8
First issued: Feb 2006
Authorised by: Mr A Riddle PR
Reviewed by: C Lewis ACU Manager Mar 2015
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Next review: Mar 2016
Electronic copy is controlled
Assisted Conception Services
Nuffield Health Woking Hospital
Centre no: 0144
STARTING TREATMENT
It is very important to have PROTECTED (use a condom) intercourse from day 1 of the cycle on
which you are starting treatment.
Day 1 of your cycle telephone the Victoria Wing to organise Treatment Planning.
1. Day 21 of cycle commence Buserelin injection or if prescribed Nafarelin nasal spray.
2. Baseline scan will be arranged 14 days later (approx).
3. If the scan shows the lining of the womb to be less than 5mm you will commence Progynova
4mgs for 6 days.(1 tablet twice daily)
4. Day 7 increase Progynova to 6mgs (1 tablet three times daily).
5. Day 13 or later of Progynova an ultrasound vaginal scan will be performed to measure the
lining of the womb.
BASELINE ULTRASOUND SCAN
Attend for your baseline ultrasound scan as instructed on your treatment plan. The scans are
performed with a vaginal probe and therefore a full bladder is not required. This scan will be
performed even if you are still bleeding. A sample of blood for Oestradiol assay may be collected
at the same time. If your scan shows any persisting cysts of follicles in the ovaries your cycle may
be deferred when it will be advisable to continue with the Buserelin injections or nasal spray for
a further week depending on the results of further scans and blood tests.
PROGRESS ULTRASOUND SCAN(S)
The scan is to assess the thickness of the endometrium (lining of the womb). It may be necessary
to have a further scan a few days later if the endometrium is not of a satisfactory thickness.
PRE-TRANSFER STAGE
Once the ultrasound scan shows the desired endometrial thickness you will be instructed by the
nurse when to: 1. Stop Buserelin injections (or nasal spray).
2. Commence Cyclogest Pessaries 4oomgs twice daily (to be inserted rectally)
3. Continue Progynova 6mgs
You need to be aware that we have 4 consultants. Any of the 4 Consultants may carry out your
embryo transfer. All of our consultants are very experienced in the field of IVF and this will in no
way compromise your chances of success.
EMBRYO THAWING
Depending on the stage at which the embryos have been frozen, they will need to be thawed
either 1 or 2 days before the embryo transfer, or very occasionally on the day of the transfer.
The embryologist will need to liaise with you during this time. It is vital that we have a current
contact number on which you will be available.
Assisted Conception Services
Pt information leaflet – FET Manipulated
Version 8
First issued: Feb 2006
Authorised by: Mr A Riddle PR
Reviewed by: C Lewis ACU Manager Mar 2015
Page 2 of 5
Next review: Mar 2016
Electronic copy is controlled
Assisted Conception Services
Nuffield Health Woking Hospital
Centre no: 0144
THE EMBRYO TRANSFER
You should report directly to the Victoria wing at the arranged time for the embryo transfer
which is usually a simple painless procedure lasting 5 to 10 minutes and does not require a
general anaesthetic,
We will ask you to tell us your full name and date of birth. Each stage of the movement or use of
embryos will be witnessed by two members of staff and you will be able to see the embryos
chosen for transfer on the TV screen. You will also be able to witness the embryologist drawing
these embryos into the Transfer Catheter if you wish. If you do not wish to view this, we ask that
you turn your head away from the screen.
If you are in the category of patients which we consider to have a very good chance of becoming
pregnant, because you have responded well to treatment – we will insist on only transferring one
embryo. If not, then up to a maximum of two embryos will be transferred. Your consultant will
have discussed this with you prior to Embryo Transfer
If you are aged 40 years or over, there are exceptionally rare circumstances when we may advise
a maximum of three embryos be transferred. Your consultant will have discussed this with you
prior to Embryo Transfer.
RISKS OF MULTIPLE PREGNANCIES
A multiple pregnancy is where 2 or more foetuses develop in the uterus at the same time.
Twins or a higher order pregnancy can undoubtedly bring many joys; both parents need to be
realistically prepared for the possibility and potential problems.
A multiple pregnancy will place a much greater strain on the mother and carries a higher risk
of miscarriage. Complications (such as high blood pressure or bleeding) are more likely to
occur and can arise earlier in the pregnancy. Most multiple pregnancies are delivered early
(before 40 weeks). The average length of pregnancy is 37 weeks for twins and 34 weeks for
triplets. There is a high rate of caesarean section for twin births and the majority of triplets
are delivered in this way.
The birth weight of twins and triplets is generally lower than that of singletons. Any pre – term
baby is more likely to die than one who is born at full term, so twins and triplets are at a much
greater risk than singletons. Babies who are born very prematurely are also more likely to have
complications which can lead to long term problems in the functioning of their lungs or heart
and in particular their brain.
The problems of caring for more than one baby can be considerable and include emotional as
well as financial aspects. There are no additional state benefits for multiple births in the UK,
yet the every day costs are much greater. The cost of nursery equipment, clothes, food and
childcare is inevitably substantial and many mothers who hoped to return to work after the
birth have found the cost of childcare makes this financially nonviable.
Many parents’ own physical and mental health suffers as a result of caring for twins or more.
Depression is more likely and this, like other problems, can affect their relationships with each
other, the wider family or friends.
For further information contact the Multiple Birth Foundation 020 3313 3519 / 020 8313 3519
Assisted Conception Services
Pt information leaflet – FET Manipulated
Version 8
First issued: Feb 2006
Authorised by: Mr A Riddle PR
Reviewed by: C Lewis ACU Manager Mar 2015
Page 3 of 5
Next review: Mar 2016
Electronic copy is controlled
Assisted Conception Services
Nuffield Health Woking Hospital
Centre no: 0144
FOLLOW UP
We advise that every woman has a pregnancy test checked 14 days after embryo transfer. During
this time you may experience increased discharge from the vagina and some low abdominal pain.
If you notice vaginal bleeding please contact the unit.
The medication you are taking may delay your period from starting even if you are not pregnant.
It is therefore important to do the pregnancy test on the correct day.
If the pregnancy test is positive you will be offered a scan to check the pregnancy. Unfortunately
about 15% of pregnancies will miscarry with a small chance of an ectopic pregnancy. You will
need to continue taking Progynova and Cyclogest until instructed when to stop.
As a requirement of HFEA you must inform the ACS unit of the outcome of your treatment cycle
and the outcome of any pregnancy.
HELP LINE
The fertility unit is staffed Monday to Friday from 07.30 to 17.30 hr.
Outside these hours an answer phone is in use. Please leave your name, date and time of your
call and contact number.
For emergencies only a member of the team is always on call and can be contacted via the unit
mobile – 077404 22717 when the unit is closed or via the main hospital switchboard 01483 227800
COUNSELLING
Our team at Nuffield Health Woking Hospital, Victoria Wing will give support, before, during and
after treatment, providing information and implications counselling, and guidance to explore
relevant issues.
Undertaking treatments can be an emotionally stressful time for you and your partner and it can
help to talk things over with someone else. We do have access to independent counsellors and
this consultation is strictly confidential. We strongly advise couples to seek independent
counselling prior to treatment especially with donor sperm.
COMPLAINTS
If at anytime during your treatment you are not happy with the standard of care will you please
tell the nurse coordinator. If you feel you wish to complain will you please write to the
complaints officer;
Ms Monnik Vleugels
Hospital Director
Nuffield Health Woking Hospital,
Shores Road,
Woking, Surrey GU21 4BY.
We are constantly striving to achieve excellence within the department; however we appreciate
that you may feel there are areas which do not come up to your expectations.
We would like to know about this.
Assisted Conception Services
Pt information leaflet – FET Manipulated
Version 8
First issued: Feb 2006
Authorised by: Mr A Riddle PR
Reviewed by: C Lewis ACU Manager Mar 2015
Page 4 of 5
Next review: Mar 2016
Electronic copy is controlled
Assisted Conception Services
Nuffield Health Woking Hospital
Centre no: 0144
WHAT YOU NEED TO KNOW BEFORE TREATMENT BEGINS
Before commencing with the proposed treatment, please ensure you have been given the
following information.
1
2
3
4
5
6
7
8
9
The limitation and possible outcomes of the proposed treatment
The possible side effects and risks of treatment
There is no guarantee that the embryos will survive the freeze / thaw process
The technique involved
All alternative treatments
The costs involved and costs of alternative treatment
The availability of counselling facilities
The possible disruption to your normal life
Your general practitioner is not obliged to prescribe the medication you may require for
your treatment.
FEE STRUCTURE
Frozen Embryo Replacement
£
See fee structure
WHEN TO PAY?
You will be invoiced by post after the transfer.
Cheques should be made payable to Nuffield Health. All major credit cards are accepted.
We also offer you the facility for 'Banker's Automated Clearing Services' (BACS) which is a
simple and cost effective way to make payments directly from your bank account to another
bank account.
For further information please discuss with our Accounts administrator.
The hospital will require details of a credit card before treatment commences, please discuss
this with the ACS Accounts Manager if this is difficult for you.
Assisted Conception Services
Pt information leaflet – FET Manipulated
Version 8
First issued: Feb 2006
Authorised by: Mr A Riddle PR
Reviewed by: C Lewis ACU Manager Mar 2015
Page 5 of 5
Next review: Mar 2016
Electronic copy is controlled