A Guide to Referral
Introduction
The Centre for Reproductive Medicine and Fertility is a purpose built dedicated centre offering a full range of assisted conception treatments for NHS and Self Funding patients. It is located on the ground floor of the new Jessop Wing.
The Jessop Hospital for Women has long been known as a centre of excellence for the investigation and management of infertile couples.
The Unit is managed by the Sheffield Teaching Hospital NHS Trust as a non-profit making service.
Professor W Ledger and Mr T C Li jointly lead the reproductive service. Mr Jonathan Skull (Clinical Director) leads the conception unit with Mr Hany Lashen (Senior Lecturer in Reproductive Medicine) and Mr. B Ola (Subspecialist in Reproductive Medicine).
When should a patient be referred?
After one year as mentioned earlier. However, in the following circumstance early referral should be considered:
Female factors
Age over 35
Amenorrhoea/oligomenorrhoea
Previous abdominal or pelvic surgery
Previous PID/STD
Abnormal pelvic examination
Male Factors
Previous genital pathology
Previous STD
Variocoele
Abnormal genital examination
Significant systemic illness
What should be considered before referring the patient?
Rubella
Rubella vaccination should be offered to non-immune women and advice given not to become pregnant within one month.
Folic Acid
Women should be advised to take 0.4mg folic acid as a supplement whilst they are trying to conceive and for the first 12 weeks of a pregnancy in order to prevent neural tube defects (NDT). The dose should be increased to 4mg daily in women who have previously had an infant with a NDT or who have epilepsy and are taking medication.
Smoking
Both partners should be advised to stop smoking.
Alcohol
Women should be advised not to drink more than one or two units of alcohol once or twice a week when trying to become pregnant.
In men there is evidence that excessive drinking can adversely affect reproduction function and general health. Therefore, men who drink excessively should be advised to limit their drinking.
Weight
The body mass index of the female partner should be calculated. A supervised weight loss programme is advised for any women with a BMI>30 whether ovulatory or not.
How will a patient be investigated?
The initial investigation of infertility includes tests of semen quality, and evaluation of ovulatory and tubal status. The consultants assess all referral letters.
The following initial investigations are usually performed;
Ovulatory Status:
Mid Luteal Progesterone – usually performed on Day 21 of a 28 day cycle. A level of greater that 30 nmol/L is suggestive of ovulation.
Early Follicular Phase FSH/LH – Performed between Days 2 and 6. This indicates whether a patient may be approaching an early menopause and is a very useful predictor of success in assisted conception treatments.
Semen Analysis:
A high quality semen analysis is essential to the evaluation of infertility. Our Andrology laboratory led by Dr Allan Pacey has an excellent reputation in investigation of male infertility including NEQAS accredited semen analysis.
Tubal Status:
This may be assessed by either hysterosalpingogram (HSG) or laparoscopy. An HSG may be arranged in many patients, but if tubal problems are suspected, laparoscopy may be more appropriate and this will be discussed in the clinic.
The referring practitioner may arrange some or all of these investigations and this may speed up the process of referral.
Should anything else be done prior to investigation?
It is often helpful to provide patients with pre-conceptual care before referral. This may include:
We are also able to offer a full range of surgical treatments, many of which can be performed by minimal access techniques
In addition, we have a team of experienced infertility counsellors who can provide supportive and therapeutic counselling to couples experiencing fertility problems.
The establishment of this new integrated fertility service allows seamless transition between the various aspects of the service providing continuity of care at all levels leading to quicker and more efficient treatment.
What is the availability of NHS funding?
All patients are eligible for investigations funded by the NHS
Treatment is available for some couples funded by the NHS, but the amount of funding and the criteria for treatment varies between different Primary Care Trusts. There may be a waiting list for NHS treatment. These issues can be discussed at the time of referral.
Patients who are not eligible for NHS treatment or who do not wish to wait for NHS funded treatment may self-fund. We are non-profit making and all fees are kept to a minimum to allow greater access to treatment.
How much does self funding treatment cost?
The unit is non-profit making and therefore we are able to offer a competitive package. Follow this link for a list of current costs.
These charges include all treatment related costs (all consultations, drugs, early pregnancy monitoring and counselling). If embryo storage is required an additional fee is payable. If a treatment cycle is abandoned some of the fee will be refunded or held in credit for future treatment.
Welfare of the Child
The law requires us to ‘consider the welfare of any child born as a result of treatment (including the need of that child for a farther), and of any other existing child who may be affected by the birth’.
More information about the welfare of the child
What are the issues regarding confidentiality?
As a licensed Assisted Conception Unit, we are bound by the Human Fertilisation and Embryology Authority’s (HFEA) rules on confidentiality. This means that we cannot pass on any identifying information without the patients written consent.
Usually patients do consent to allow us to pass on details of their treatment to the GP or referring practitioner, but occasionally they wish the treatment to remain completely confidential and we have to respect that.
Please note that if information is given to you, details should not be recorded in other records, particularly records of any children born as a result of treatment.
Who can I contact for further information
Further guidance and information about the investigation and management of infertility can be found on the Royal College of Obstetricians and Gynaecologists website.
If you would like any further information please contact
Val Kitcheman - Business Support Manager on 0114 226 8501
