The Fertility_Gyna Acad Brochure_v8.indd

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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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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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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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%
-
-
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.
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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.
2.
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
5.
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.
6.
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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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: [email protected]
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 Regent’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.