Preparing for IVF

How can I prepare for my appointments at the fertility clinic?

It’s natural to feel a bit apprehensive before attending your first clinic appointment. But remember that your clinic has your best interests at heart. They’ll have supported many people through the same process you’re going through and will hopefully understand how daunting and new this whole experience is for you.

At your appointments, don’t be afraid to ask as many questions as you need to. You (or the NHS) are paying for a service and it’s the clinic’s responsibility to ensure you understand and are comfortable with everything that’s happening. You might find it helpful to print of the questions below and take a notepad and pen with you.

You should also take your time to think through any decisions that need to be made, and get advice or support from alternative sources if you need to. Never feel pressured to rush into a decision that you’re not 100% happy with.

Questions about treatment to ask your fertility clinic

• What are the benefits of the treatment you've recommended and why do you think it's the best option for me?
• How many patients at your clinic have had this treatment in the last two years and how many of them have become pregnant/had a baby?
• Are there alternative treatments? If so, what do they involve, and why do you think they are less suitable for me?
• What other options are available if this treatment doesn't work?
• How does my age affect the choice of fertility treatment?

Questions to ask your clinic about treatment add-ons

Whether you are receiving fertility treatment through the NHS or are self-funding, before using a treatment add-on, it is important to make sure you have the information you need about why this has been recommended to you and how much you will be charged for it.

• Your clinic may offer you optional additional treatments called treatment add-ons, on top of your routine IVF treatment, for example, time-lapse imaging, endometrial scratch or EmbryoGlue.
• For some treatment add-ons there is not enough evidence to show that they are effective at improving the chances of having a baby for most fertility patients.
• They are likely to involve an additional charge on top of the cost of a routine cycle of IVF. Some treatment add-ons can cost hundreds or thousands of pounds each.

Key questions to ask your clinic about treatment add-ons

• Why are you recommending this add-on for me specifically?
• Can you tell me what my chances are of getting pregnant with routine IVF compared to my chances if I have this add-on?
• Do you believe the add-on is safe?
• What is the additional cost of the add-on and what is included?
• Will it be more effective if I spend my money on subsequent rounds of routine IVF (if necessary) rather than use this add-on?
• Can costs change during my treatment? If so, will these be discussed with me before any decisions are made?
• Will you, or anyone employed by this clinic, benefit financially from me having this add-on?
• Where can I go for more information and who do I contact if I have further questions?

Detailed questions to ask your clinic about treatment add-ons

It may not be necessary for you to ask your clinic every question. You may find the answers to some of these question in our treatment add-ons information or elsewhere on our website.

 Evidence and suitability

• How does this add-on work?
• Is there good quality evidence to back this up?
• Are there any associated risks or side effects from having this add-on?
• What are the chances of getting results from add-on tests that aren’t accurate? Could that lead to more testing?
• Will having the add-on delay my treatment?
• Will I have to make extra visits to the clinic if I have this add-on?
• What if I don’t have the add-on?
• Would there be different options if I were treated on the NHS rather than privately?
• Can I or you change my treatment plan part way through? If so, can we discuss those options before I start treatment?

Cost

• Will my itemised bill break down the cost of the individual treatments I will receive?
• Do you charge the same for this add-on as other clinics?
• What is the cost of two cycles with no add-ons vs one cycle with this add-on?
• If I remove this add-on from the package of treatments recommended, will this affect the cost?
• If I have questions about what I am being charged for, can I discuss these with a healthcare professional before making a payment?
• What are the refund and cancellation policies at this clinic, and can I have a copy?
• What are the time limits associated with this package of treatment?               

Questions to ask yourself

• Have I read the information on the HFEA website for the add-on I am considering?
• Am I assured that it is safe, and do I know about any possible risks?
• Am I aware of how much difference, if any, this add-on might make to the outcome of treatment?
• Would paying for this add-on affect my chances of being able to afford another routine IVF cycle if I need it?
• Have I been given an itemised bill by the clinic?
• Am I happy with the cost?

Questions about medication, tests and wellbeing to ask your fertility clinic

• What medication will I have to take and what side effects may they cause?
• Can I get my medication from elsewhere?
• How will I take the medication?
• Are there any alternatives to the medications you have mentioned?
• Which tests will I need to have and why?
How much will they cost?
• How can I change my lifestyle to boost my chance of success?
How will this help?
• What physical and emotional symptoms can I expect from treatment?

Questions about support to ask your fertility clinic

• What kind of counselling or advice service do you provide? What can it help me with?
• Is there a charge for counselling, or how many free sessions can I have?
• If I don’t take up counselling now, will you reoffer it at a later date?
• Does this clinic have a patient support group I can join or are there other support groups that you would recommend?
• Could you tell me more about how you will assess me before you give the go-ahead for treatment?
• Can I have the contact details for someone to answer medical or other questions?
• When is the best time to phone you?

Your clinic is required by law to offer you counselling

Questions about costs to ask your fertility clinic

• Can you break down all the costs of this treatment?
• Are there any other costs that might arise? Your clinic should provide you with a costed treatment plan.
• How can these costs be reduced?

Questions about administration to as your fertility clinic

• How many times will I need to visit the clinic?
• What consents do I need to provide and why?
• How will my personal information be used?
• Have you recorded my partner’s name and contact details as well?

Next steps

• What happens next?
• Do I (and/or my partner) need to do anything now?
• What support is provided if treatment stops or fails?

Using a donor

If you’ve decided to use donor eggs, sperm or embryos in your treatment, you might like to ask some additional questions including:

• Why has IVF been recommended and not intrauterine insemination (IUI), or vice versa?
• Will both my partner and I be the legal parents of the child?
• What information can I find out about my donor?
• What information can my child find out about the donor?

Find out more about using a donor

What to expect at the fertility clinic

When you start treatment at a clinic, what happens next will depend on your circumstances. In many cases you’ll start treatment straight away, but in others you may be given further fertility tests if your existing tests haven’t identified the cause of infertility. These tests can include:

For women

• A full hormone profile taken between days two to four of your period to assess for any hormone imbalance.
• Blood tests to find out if you are ovulating. 
• An ultrasound scan to look at your uterus and ovaries.
• Follicle tracking – a series of ultrasound scans to follow the development of a follicle to see if an egg is developing.
• Hysterosalpingogram – an x-ray to check your fallopian tubes.
• Laparoscopy – an operation in which a dye is injected through your cervix as the pelvis is inspected via a telescope (laparoscope) with a tiny camera attached to check for tubal blockage.
• Hysteroscopy – a telescope with a camera attached is used to view your uterus to check for conditions such as fibroids or polyps.
• Hysterosalpingo-contrast sonography (HyCoSy) – a vaginal ultrasound probe is used to check the fallopian tubes for blockages.
• Occasionally, a tissue sample may be taken from the lining of your womb to be analysed.

For men

• Semen analysis to check sperm numbers and quality.
• Sperm antibody test to check for protein molecules that may prevent sperm from fertilising an egg.

Find out more about fertility tests on the NHS Choices website

In 33% of cases the cause of infertility is unexplained. It can understandably be frustrating not knowing what the problem is and how to fix it but sadly fertility treatment isn’t an exact science. How you handle this is up to you: some people prefer to let their consultant make decisions in their best interests whilst others like to do as much research as possible into their situation so they can make decisions about how to move forward jointly with their treating clinician.

What health tests will I need to have?

Before having treatment, everyone involved must have health checks to prevent certain serious conditions from being passed onto the mother or child. You’ll be tested for: 

• HIV 1 and 2 (Anti-HIV – 1, 2)
• Hepatitis B: (HBsAg/Anti-HBc)
• Hepatitis C: (Anti-HCV-Ab)

If you’ve travelled recently, you may also be tested for infectious diseases such as malaria, so make sure you let your clinic know about any recent trips abroad. Your clinic will take a detailed travel history from you and may decide to defer treatment if you have been to a country affected by infectious diseases such as Zika or Ebola.

You should tell your clinic if you’ve recently travelled abroad

What does giving ‘consent to treatment’ mean?

Before treatment can take place, your clinic should help you to complete a number of consent forms to ensure your sperm, eggs, embryos and personal information are used in a way that you’re happy with. You should take the time to understand exactly what you’re giving consent to and that you’ve thought through all the implications.

It’s possible for you to withdraw your consent providing your eggs, sperm and embryos haven’t already been used in treatment, research or training (depending on what you consented to.) Your partner or donor can also change or withdraw their consent at any time until their eggs, sperm or embryos have been used in treatment. If that happens, you wouldn’t be able to continue with treatment, even if the embryos have been jointly created with your eggs or sperm.

Find out more about giving consent