This treatment option can be appropriate for patients who have an irregular cycle and do not produce an egg each month. Provided the semen analysis is normal and the fallopian tubes are open, we generally advise ovulation induction as first line of treatment.

This involves taking a simple fertility drug called Clomifene (Clomid) for five days from day 2 of the cycle and we arrange an ultrasound scan 'follicle tracking' from day 8 or 9 of the cycle to check the ovaries are responding to the drug and producing a follicle.

We then advise timed intercourse. When there is no response to Clomifene or if conception has not occurred after a couple of cycles, we recommend treatment with injectable fertility drugs called Gonadotrophins.

These drugs are more potent than Clomifene and require close ultrasound scan monitoring every cycle, as the risks of a multiple pregnancy are much higher.

If you are significantly overweight or underweight you are unlikely to respond well to ovulation induction treatment (or any fertility treatment). Your doctor will check your Body Mass Index and may recommend deferring treatment.

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This treatment involves the insertion of prepared sperm from either the partner or a donor into the womb at the most fertile time of the monthly cycle.

Insemination using sperm from the partner can be appropriate when there is unexplained infertility or difficulties with intercourse.

The treatment may be carried out with or without the use of fertility drugs, depending on your circumstances. Ultrasound scan 'follicle tracking' is used from day 8 or 9 of the menstrual cycle to time insemination accurately.

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In this treatment, eggs are removed from the ovaries, fertilised with sperm in a laboratory dish and allowed to grow before replacing in the womb. IVF can be appropriate in the following circumstances:
• If damaged or blocked fallopian tubes stop sperm from reaching the egg
• If sub-optimal sperm quantity or quality reduces the chance of fertilisation
• If there is unexplained fertility or resistance to conventional ovulation induction techniques

In the unlikely event of failure of the Centre (such as staffing issues, or equipment failure), we may require to transfer patients to another local IVF centre for on-going care. A Third Party Agreement is in place with Hammersmith IVF Unit so as to cover such eventualities.

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ICSI involves injecting a single sperm directly into an egg in order to fertilise it. The fertilised egg is then transferred to the womb. It can be a suitable treatment when sperm quantity or quality is poor such that conventional IVF would lead to low or no fertilisation. The treatment protocols, egg collection and embryo transfer techniques are the same as for IVF.

The only difference occurs in the laboratory after egg collection when, rather than allowing the egg and sperm to interact in the dish, a single sperm is injected into the centre of each egg using a micro-injection needle.

For more information, read our ICSI Patient Information Sheet.

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Egg freezing is an increasingly common treatment. There are 2 main reasons why a person may choose to freeze their eggs:

1. They are due to undergo treatment which may affect the ovarian reserve or fertility (for example cancer treatment such as chemo- or radio- therapy, gynaecological surgery, or gender identity treatment). We have facilities to freeze eggs at short notice should this be necessary.
2. When someone is not ready to have a pregnancy and wishes to freeze eggs to increase their chances of pregnancy in the future.

The egg freezing process involves injections to stimulate the ovaries over a period of approximately 2 weeks. This is then followed by an egg collection procedure and freezing of the mature eggs. Frozen eggs can then be thawed and used in an IVF/ICSI cycle in the future.

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Embryo freezing may be undertaken electively for social reasons or as part of a planned fresh IVF/ICSI cycle. In a fresh IVF cycle, when there are several embryos of good quality, it is generally recommended to freeze embryos which are not used. These embryos can be used at a later date should the original cycle not be successful or should there be a live birth and the couple want to have another child. Sometimes we recommend not going ahead with a fresh embryo transfer and advise freezing all the embryos, for example if there are concerns regarding your risk of Ovarian Hyperstimulation Syndrome (OHSS) or problems have been identified with the womb lining.

The process of Frozen Embryo Transfer (FET) is much easier (and less costly) than a fresh cycle. Usually we monitor the menstrual cycle with ultrasound. When the stage is reached at which a naturally occurring embryo would be ready to implant, we defrost the embryos for a transfer similar to that for an IVF cycle. Unfortunately, not all embryos survive the freeze/thaw process, but since the newer freezing technique of vitrification has been used, embryo survival after thaw is above 80%.

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For single women, female couples and people who wish to conceive with donor sperm we provide a number of treatment options including donor intrauterine insemination or IVF. We have links with a number of UK and international sperm banks from where you can select a donor. Please make an appointment with one of our consultants who will make a full assessment and advise which treatment may be most appropriate.

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We see both NHS and private referrals for fertility preservation for transgender and non-binary people. This may involve freezing sperm, eggs or embryos. NHS patients can be referred by their GP or gender clinic and private patients can self-refer by contacting us directly.

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This service has been developed for couples who wish to have a child but where the male partner is HIV positive and the female partner is HIV negative (referred to as HIV-discordant status).

The aim of the treatment is to reduce the risk of HIV transmission by attempting to achieve conception through insemination of sperm that has been washed free of HIV rather than through unprotected intercourse. We were the first clinic in the UK able to offer sperm washing to couples. There are more than 25 clinics worldwide now offering the treatment. The combined results from all these clinics indicates that in more than 5,000 inseminations or other fertility treatments carried out using washed sperm (prepared according to published guidelines), there have been no reported cases of HIV transmission to the female partner or to the resulting child.

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Some patients have no sperm in their ejaculate because it has been intentionally blocked by surgery (vasectomy), blocked by infection, or congenitally blocked. It is commonly possible to obtain sperm in these situations which can be used for an ICSI cycle. The procedure is usually performed under anaesthetic in advance of any egg collection. The sperm are then frozen and stored for future use. The Fertility Centre offers both NHS and private andrology services for male or sperm-related fertility issues. Please contact us for further information.

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The shape of the sperm (morphology) is important in diagnosing male or sperm-related fertility problems and in predicting fertilisation and pregnancy outcomes. Studies have shown that selecting better-shaped sperm improves your chances of a successful clinical outcome.

IMSI (Intracytoplasmic Morphologically Selected Sperm Injection) is a variation of ICSI that uses a higher-powered microscope to select sperm. Normally, the ICSI technique is performed with a 200x-400x light microscope. IMSI requires a latest generation light microscope (enhanced by digital imaging) with a magnification of up to 2700x. This allows the embryologist to detect subtle structural alterations in sperm and select spermatozoa with the most normally shaped nuclei (which contain the sperm's genetic material).

IMSI may be recommended to those patients who have had failed IVF/ICSI cycles in the past, or for couples who have a component of male infertility (especially in cases when patients present a high percentage of morphological anomalies in their sperm). 

Although initial studies showed that IMSI is associated with an increased pregnancy rate in couples with repeated implantation failure, there is little evidence from randomised controlled trials to support better livebirth rates.  This technique will only be offered when your doctor deems it appropriate for your treatment.

For further information and evidence including independent reviews please visit the governing body Human Fertilisation & Embryology Authority (HFEA) website on https://www.hfea.gov.uk/treatments/treatment-add-ons/: this technique has currently been deemed as grey in the HFEA traffic-light system for additional treatment options.

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During IVF and ICSI fertility treatment a fertilised embryo will be transferred into the patient's uterus. The aim of the treatment is that the embryo will successfully implant itself into the lining of the uterus where it will grow and develop. However, sometimes the embryo does not implant and the fertility treatment cycle is unsuccessful.

EmbryoGlue® is a medium developed to closely resemble the environment in the uterus at the time of implantation. It is not a glue in the common sense but acts as an adhesive by increasing the chance of implantation of the embryo to the uterus. The embryos are placed in the solution and allowed to soak in it for a fixed period prior to the transfer. There is some evidence that suggests that the presence of hyaluronan in the transfer medium has a positive effect on clinical pregnancy rates and livebirth rates for both Day 3 and 5 (blastocyst) transfers.  This technique has been reported to be advantageous for a selected category of patients, in particular those with previously failed implantation. EmbryoGlue® may also reduce the miscarriage rate. However, further studies of adherence compounds with embryo transfer need to be undertaken.

It is important for you to make an informed decision on what option is right for you. For further information and evidence including independent reviews please visit the governing body Human Fertilisation & Embryology Authority (HFEA) website: https://www.hfea.gov.uk/treatments/treatment-add-ons/

This technique has currently been deemed as amber in the HFEA traffic-light system for additional treatment options. 

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An egg is surrounded by a shell which is still present in the early embryo. To implant in the womb, the embryo must break through this outer coat – a process known as hatching. It has been suggested that sometimes hatching fails to occur which may provide an explanation, at least in part, as to why some couples fail to achieve a pregnancy.

Assisted hatching is a procedure that involves a hole being made in the shell of the developing embryo, generated from either an IVF or ICSI treatment, to aid the natural process of hatching. This is performed on either Day 3 or Day 5 following egg collection approximately 30 minutes before the embryos are transferred.

This technique has been reported to be advantageous for a selected category of patients, such as:

• those with advanced maternal age (>38 years)
• those with repeated failed treatment cycles despite good embryo quality
• those having a frozen-thawed embryo transfer cycle

Current literature has reported some evidence of increased rates of clinical pregnancy following this procedure in the above groups, however, more randomised controlled trials are needed to find out whether AZH can have an effect on live birth rates and to examine the consequences for children born as a result of this procedure.  This technique will only be offered when your doctor deems it appropriate for your treatment.

For further information and evidence including independent reviews please visit the governing body Human Fertilisation & Embryology Authority (HFEA) website : https://www.hfea.gov.uk/treatments/treatment-add-ons/

This technique has currently been deemed as grey in the HFEA traffic-light system for additional treatment options, where there is no evidence from randomised clinical trials to show that it is effective at improving the chances of having a baby for most fertility patients.

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An endometrial scratch is a procedure that is performed to try to improve the chance of implantation when an embryo is transferred back in to your uterus.

The lining of the uterus (the endometrium) is gently 'scratched' using a thin catheter (a fine, flexible, sterile, plastic tube) which is passed momentarily through the cervix. This does not cause any harm to the lining of the uterus.

Available evidence suggests that there may be some benefit from an endometrial scratch in patients with repeated IVF implantation failure. For further information please visit the governing body Human Fertilisation & Embryology Authority (HFEA) website : https://www.hfea.gov.uk/treatments/treatment-add-ons/

This technique has currently been deemed as amber in the HFEA traffic-light system for additional treatment options.

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