At your second appointment we will do some investigations.
As well as blood tests needed for genetic testing, a blood test will be taken between day two to day four (day one being first day of a period) of your menstrual cycle to measure your hormone levels.
This helps us to decide the dose of medication to use for the treatment. It is a national recommendation that all men and women having IVF treatment have a blood test for Hepatitis B and C and HIV. We have decided to extend this recommendation to all couples having any form of treatment in the Assisted Conception Unit (ACU). This is important because a positive result can impact on:
- your health;
- the health and well being of any child conceived from treatment;
- the likelihood of the virus being passed on.
It is also necessary to do these tests if we are to freeze any extra embryos that are created during treatment.
We may offer treatment to a couple if one partner has a positive result but would recommend you are seen by a specialist doctor for further advice before starting PGD treatment.
At this visit, you (the female partner) will have a trans-vaginal (internal) ultrasound scan, which involves placing a small probe inside the vagina to look at the uterus and both ovaries.
This is to check for any problems that might reduce the chances of successful treatment. Problems include:
- cysts in the ovaries
- some types of damaged fallopian tubes
- fibroids in the uterus.
If a problem is found, further investigations and surgical treatment might be needed before you start treatment. Most women find this procedure is not as uncomfortable as a smear test.
During your second appointment it is usual to examine at least one semen sample in our laboratory, even if you have no fertility problems or have had one done elsewhere. This is because different laboratories use different criteria for assessing sperm. We use World Health Organisation standards and will take responsibility for any treatment recommended, based on our assessment.
Producing a semen sample
- You should not have intercourse or masturbate (by hand) for two to three days before producing the sample as both of these can affect the quality of the semen.
- You can produce the sample in a room in the unit, which is specifically for this purpose. Alternatively, you can produce the sample at home if the travelling time to the unit is less than two hours.
- You produce the semen sample by masturbation.
- If masturbation is likely to be a problem, we can give you a special condom to produce the sample during intercourse. This condom does not contain a lubricant that kills sperm. The sample must still reach us for analysis within two hours of production.
- Do not use soap or lubricants immediately before producing the sample, as they are toxic to the sperm.
- Collect the whole sample in the container provided.
- It is extremely important that you label the container with your name, your partner's name, the date, the time the sample was produced and the date of your last ejaculation. All of this information is necessary for safe and accurate identification, processing and interpretation of the result.
- Do not allow the sample to become too cold if you produce it at home. Place the container in your pocket or your partner's handbag.
If you think you may have difficulty producing a sample, please let us know. We can arrange for your semen to be collected and frozen for future treatment.
Occasionally the male partner of a couple requesting PGD does not have any sperm at all (azoospermia).
This might be because:
- of a blockage in the connecting passages from the testicles – called obstructive azoospermia or
- very few sperm are being produced in the testicles – called non-obstructive azoospermia.
As only one sperm is needed per egg for Intracytoplasmic Sperm Injection (ICSI), we can use a surgical procedure-Percutaneous Epididymal Sperm Aspiration (PESA), testicular sperm aspiration (TESA) or testicular sperm extraction (TESE) to obtain small numbers of sperm directly from the testicle. These procedures will be discussed if appropriate to you.