Wednesday 27 April 2011

IVF case study

Lucy and Graheme had been trying to conceive for two years before they came to SEFC. Lucy, 28 years was a legal assistant and Graheme 27 years, a warehouse manager. The couple were both in good health.
Previous investigations had been carried out at their local hospital. 
A Laparoscopy under general anaesthetic allowed Lucy's gynaecologist to assess her pelvis. This showed pelvic adhesions with both fallopian tubes being blocked. Graheme had a normal semen analysis. In view of the obvious tubal damage the couple were advised to seek treatment by in vitro fertilisation (test tube baby technique).
The couple went for consultation at SEFC where the Consultant confirmed the need for IVF. Treatment would involve a course of ovarian stimulation by injection to produce approximately 10-12 eggs followed by an egg collection. Lucy would have to attend for three or four ultrasound appointments to watch the follicles, which contain the eggs, develop. The eggs would be harvested as a day case procedure, under sedation, using transvaginal ultrasound. The eggs would then be inseminated to achieve fertilisation and up to two embryos transferred to the uterus after three days. Typical pregnancy rates were in the order of 35% at embryo transfer. As Lucy was under 35 years, the couple were asked to consider egg sharing as an option. This would involve undergoing IVF but giving half of the eggs gathered to an anonymous recipient who herself needs donated eggs to get pregnant. In return for this the cost of treatment would be heavily subsidised. If less than eight eggs were collected the couple would keep all the eggs for their own treatment at no additional cost. Prior to taking part in the scheme the couple would need to undergo thorough screening to ensure good health and implications counselling to ensure they were happy to take part in the scheme. The couple were given the ‘Patient Information Book’ which describes all treatments at SEFC in detail.
After consideration, Lucy and Graheme decided they would like to have IVF within the egg share scheme. Screening tests were normal and counselling raised no issues with regard to treatment. Lucy had a nurse consultation to plan a treatment cycle and to complete a number of consent forms.
Lucy underwent a course of ovarian stimulation and responded well to the medication. The egg procedure was uncomplicated and nine eggs were collected. Lucy and Graheme were given five eggs for their own treatment 
and four were donated to another couple. Two of the eggs fertilised normally. Three days later two good embryos were available for transfer. The couple were not keen on a twin pregnancy and elected to have just one embryo transferred to the uterus.
Lucy and Graheme had a positive pregnancy test two weeks later and the pregnancy scan at seven weeks confirmed a foetal heartbeat. The couple were advised to contact their family doctor to arrange antenatal booking.

Cost:
Lucy and Graheme paid £160.00 for their initial consultation. All screening tests and the HFEA licence fee cost approximately £1000.00. There was no cost for Lucy’s medication as this was included in the egg share scheme. Normally a single attempt at IVF would have cost them a total in the order of £3500.00. A detailed and up to date price list is available from the clinic.

Comment:
IVF is an expensive type of fertility treatment and may require more than one attempt. For many young couples IVF can be simply unaffordable. There are a large number of women who require donated eggs to start a family and waiting lists can be long. IVF with egg sharing is available to suitable women under the age of 35 years. It can make treatment accessible to many couples and allows another woman to be helped.
Typical pregnancy rates for IVF are around 35% at embryo transfer. Multiple pregnancy rates are in the order of 20%. Many couples are happy with the idea of a multiple pregnancy although there is no doubt that multiple pregnancies can be more complicated. Lucy and Graheme elected to have a single embryo transfer to minimise any risk. Single embryo transfer is becoming a more popular decision for many couples.
At SEFC we believe that the egg share scheme offers couples access to high quality affordable fertility care with no compromise on the pregnancy rates. It also reduces the waiting time for those women who require donated eggs.

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