Before starting any treatment, we will assess your detailed family and medical history, perform a physical examination and vaginal ultrasound scan and blood tests measuring hormonal levels. Chromosome abnormalities and blood clotting disorders can be diagnosed with genetic testing and immunological testing may identify antibodies preventing implantation. Specific tests may include:
- Ovulation examination: This test attempts to determine whether ovulation has taken place and also includes hormonal testing
- Genetic testing for inheritable conditions
- Screening for blood clotting disorder
- Immunological testing including screening for antibodies against sperm, ovarian antibodies and trophoblast. If needed, patients may be referred to a reproductive immunologist or an endocrinologist
- Hysterosalpingogram (HSG): A method to evaluate the fallopian tubes and uterus
- Hysteroscopy to examine the uterus from within, as well as minor surgical procedures such as the removal of polyps, adhesions and smaller fibroids
- Laparoscopy is additionally used to inspect the pelvic region enabling treatment of ovarian cysts and the evaluation of the fallopian tubes
Please find below more information on individual female investigations that are offered at City Fertility for both patients and out-patients. Please note that out-patients are required to provide us with a referral letter from their treating clinician or GP.
For more information or to book any of the below, please get in touch.
Cycle Monitoring (Ovulation Induction)
We can help diagnose fertility conditions using ultrasound scans and appropriate a blood tests. Investigations can look at ovulation and the way the dominant egg-containing follicle develops. Ovulation Induction uses oral and/or injected medications to boost the chances of fertilisation.
3D Saline Infusion Sonohysterography (AquaScan)
A saline sonohysterogram, also known as an AquaScan, is a simple ultrasound procedure that looks at the endometrial cavity (the inside part of the uterus) and the endometrium (the lining of the uterus). It is usually performed in the ultrasound scan room and no sedation is needed but we are happy to offer a simple analgesia before the procedure upon request.
What does a saline sonogram involve? A speculum is inserted in the vagina to visualise the neck of the womb (like in a smear test). The neck of the womb (cervix) is cleaned and then a small soft catheter is passed gently through the neck of the womb into the cavity of the womb. An internal scan allows the lining of the womb to be seen clearly whilst some warm saline (salt water) is passed through the soft catheter. The endometrial cavity distends which enables the doctor to visualize the endometrial cavity. Any filing defect is noted and 3D images are taken.
3D saline sonography can diagnose polyps and fibroids in the uterus, an abnormally shaped uterus, intrauterine adhesions and a uterine septum which may be associated with subfertility, recurrent IVF failure and recurrent miscarriages. 3D/4D imaging of the uterus during the sonohysterogram is particularly useful for the assessment of congenital uterine anomalies.
3D HyCoSy (Tubal Patency Test)
A HyCoSy, also known as Hysterosalpingo-contrast sonography, is an ultrasound used to show the flow of fluid through the Fallopian tubes. It is very similar to the Saline Sonography (Aqua Scan) procedure but uses a contrast solution instead of saline to assess your fallopian tubes. This technique allows for identification of any blockage, which may be present in the Fallopian tubes.
What does a HyCoSy involve? The examination takes approximately 30 minutes and no anaesthetic is required. A catheter is passed into the vagina through the cervix into the uterus (womb). A small balloon is then inflated to keep the catheter in place. The contrast medium is then injected into the uterus through the catheter. The injection of the contract medium may cause some discomfort similar to the uterine cramps experienced during menstruation. A vaginal ultrasound scan is undertaken at the same time allowing your doctor to view the contract medium flowing through the Fallopian tubes.
The procedure should be performed after menstruation has ended in the first half of the cycle (usually from day 6 - day 12 of your cycle). It is recommended that you avoid intercourse from the first day of your last menstrual period up to the day of the procedure. Your treating clinician may suggest you have a high vaginal swab and chlamydia screen performed to exclude infection prior to the HyCoSy. An alternative is to cover the procedure with antibiotics.
Diagnostic and Operative Hysteroscopy
A hysteroscopy is a procedure during which the inside of the uterus (womb) is examined using a thin narrow tube called a hysteroscope. The hysteroscope (2-5mm diameter) is carefully passed through the vagina, the cervix (neck of the womb) and enables the doctor to see into the uterus via the hysteroscope telescope to assess the inside of the uterus and the opening of the Fallopian tubes. The procedure can diagnose polyps, adhesions and fibroids which can be removed at the same time (operative hysteroscopy).
The images may be viewed on a computer monitor as the hysteroscopy is being done. It can help to give a clear diagnosis of problems you are experiencing and help to decide the right treatment for you. These problems/symptoms you might be experiencing can include:
- Repeated unsuccessful fertility treatments;
- Previous uterine surgeries (e.g. caesarean, fibroids removal)
- History of complicated or repeated miscarriages
- Heavy or irregular vaginal bleeding
- Post-menopausal vaginal bleeding
- Unusual vaginal discharge
- For the diagnosis of womb cancer.
If you have regular cycles, the procedure should be performed after menstruation has ended in the first half of the cycle (usually from day 6 - day 12 of your cycle). It is recommended that you avoid intercourse from the first day of your last menstrual period up to the day of the procedure. Your consultant may suggest you have a high vaginal swab and/or chlamydia screen performed to exclude infection prior to the hysteroscopy. An alternative is to cover the procedure with antibiotics.
An operative hysteroscopy may involve removing:
- Polyps (small lumps of tissue growing on the lining of the uterus)
- Scar tissue and adhesions inside the uterus
- Fibroids (non-cancerous growths)
- Locate a 'lost' / stuck contraceptive device
- Ablate endometrium
- Divide a septum.
If extensive treatment is expected, an operative hysteroscopy may require you to have a general anaesthetic (when you are asleep). You should not have a hysteroscopy if you are pregnant, have a vaginal or urinary tract infection or if you have cancer of the womb.
Endometrial Receptivity Assay ERA
ERA is a novel diagnostic method that looks at the endometrial receptivity status of a woman, from a molecular point of view. This test is indicated in cases of recurrent implantation failure with good quality embryos.
A biopsy of endometrial tissue is performed seven days ovulation in natural cycles or 5-6 days after the start of Progesterone in a medicated mock cycle. This biopsy is carried out by a doctor and is a simple procedure.
The results will tell us if your endometrium (womb lining) is receptive to an embryo at the day the biopsy is performed. If it is found to be post-receptive we can tailor future embryo transfers to take place earlier. If your endometrium is pre-receptive we may advise that embryo transfers take place a day later than usual.
The majority of miscarriages happen due to randomly occurring chromosomal abnormalities in the embryo. These errors may originate in the egg, in the sperm or occur after fertilisation as the embryo develops. In the vast majority of recurrent miscarriages, no specific condition is found despite extensive investigations.
Conditions linked to recurrent miscarriage are:
- Specific conditions with a clear link to recurrent miscarriages;
- When either the male or female partner carries a balanced chromosomal translocation;
- When the female partner has an antiphospholipid syndrome;
- When the female partner has a significant level of anti-thyroid antibodies and thyroid dysfunction;
- In the presence of uterine anomalies;
There are other conditions which may contribute to recurrent miscarriages, but the links have not been well established. These include problems in reproductive immunology, conditions other than antiphospholipid syndrome which cause clotting problems (thrombophilia) and high sperm DNA fragmentation.
The doctor who oversees your treatment will discuss the use of testing for any of the above conditions relevant to your medical history.
Recurrent implantation failure
The conditions contributing to recurrent implantation failure are very similar to those contributing to recurrent miscarriages.
The doctor who oversees your treatment will discuss the use of testing for any conditions relevant to your medical history.
NACE, Non-invasive Prenatal Test
At GENNET City Fertility we feel that all pregnant women should have a worry-free pregnancy and in order to enjoy a peaceful and healthy progress we do offer NACE testing.
NACE® is a non-invasive prenatal screening test that analyses the most frequent chromosomal alternations without compromising the pregnancy. A simple peripheral blood extraction from the mother allows free DNA circulating in the maternal plasma to be detected via Next Generation Sequencing technology and advanced bioinformatic analysis.
NACE is a complete prenatal test to detect abnormalities in chromosomes 21, 18 and 13 (Down, Edwards, and Patau syndromes). It also detects the most common abnormalities in the sexual chromosomes X and Y (except for twin gestations). The NACE test detects foetoses with chromosomal abnormalities with very high precision.
The NACE test allows the testing in twin pregnancies (aneuploidies for sex chromosomes not analysed, presence or absence of Y chromosome informed), vanished twins and egg donation. It is especially recommended for women with:
- An abnormal result in their first trimester screen
- A previous Down syndrome pregnancy
- A suspicious ultrasound finding
NACE® Extended 24 incorporates the detection of all 24 chromosomes and identifies five microdeletions associated with major genetic syndromes.
What happens in the case of a positive result?
In cases of positive results patients are recommended genetic counselling and comprehensive ultrasound examination, at the same time the results should be confirmed by genetic diagnostic testing.
Depending on the screening results, diagnostic testing approach should be karyotype and:
- Rapid prenatal testing by qfPCR
- Rapid prenatal testing by FISH
- Microarrays for prenatal diagnosis
The use of reproductive immunology tests is controversial and is not routinely practiced at GENNET City Fertility. We do offer a series of tests for selected patients upon request. The consultant who oversees your case will discuss the option of performing such tests with you in detail and with full transparency. Should you decide to carry out the tests and they highlight an immune issue, we will discuss the use of immune modulators such as steroids and intralipid treatments.