Your Patient Journey
Everyone's journey slightly differs, but I thought it might help to understand how we might work together. Please do get in touch if you have any questions.
It is usually best to see couples together so that our plans and conclusions can be shared and thoroughly discussed at the time. Although every consultation is followed-up with a personalised report of our findings, there is no substitute for a very thorough 'one-to-one', or in this case 'one-to-two' meeting.
We commonly see several different situations which are usually amenable to investigation and often lead to treatment - the key is diagnosis.
The most frequent reason for referral is failure of IVF, presumed to be due to male factor. Couples are understandably often quite damaged by repeated failures, without obvious explanation, and usually without much attention to the male factor, on the basis that 'nothing can be done' except further cycles with or without donor gametes.
Sometimes a DNA Fragmentation Test will have been done, but the implications of an abnormal result may not have been fully explained. In these cases it is often possible to discover the cause of the abnormal fragmentation, and to improve sperm quality. Although the evidence that such improvements translate to higher live birth rates is hard to find, it is equally true that few studies have addressed this question.
We are beginning to see a few couples who have had investigations rather sooner, perhaps after one or two failed cycles, and it is intuitively correct to examine, further investigate and treat the male partner before repeating a procedure which has already failed without attempting to change any of the variables on the male side. The belief that 'nothing can be done to improve male fertility' has so often been repeated that it has achieved an almost religious importance in fertility units across the world, particularly in the UK, where credit should be given to gynaecologists and healthcare providers for making IVF more available to a greater number of couples. The availability of IVF does not however negate the possibility that many men's fertility can be improved before they embark on the process.
The second most frequent reason to seek our help is the surprise and often shocking finding that there are no sperm in the ejaculate- Azoospermia. This finding needs careful and sensitive further investigation and may lead to a micro TESE (sperm retrieval) or FNA diagnostic procedure.
Men with presumed fertility problems require individual care, diagnosis and advice. Some patients have felt abandoned by the doctors who can do so much for their partners, and sometimes they feel guilty that there seems to be so little they can do to help the situation. My practice in men's fertility aims to answer three important questions:
- Firstly, is there a 'male factor' problem?
- Secondly, can we diagnose a cause?
- Thirdly, can we offer straightforward (evidence-based) treatment?
We would normally aim to answer these questions in two or three consultations. So that both partners may be present, appointments can be made in the evenings and on a Saturday morning at the Spire Clinic in Windsor, where close liaison with the local specialist gynaecologists is possible.
At the Beaconsfield Clinic, in association with Ms. Claire Mooney and Fertility Solutions, all tests can be done onsite. Although costs of laboratory tests may be slightly more expensive at Beaconsfield due to courier charges to London, the ultrasound scan is less expensive and of course all tests including consultation are carried out one visit thus reducing travel costs and parking is free!
The first appointment, or initial consultation, is often the most important.
Everyone is different, and it's my job to work closely with you to work out what your individual journey and potential course of treatment and support might be. Expect to be asked lots of questions!
This appointment will include understanding more about what your symptoms are, your full medical history and a physical examination. We might discuss the need for some additional tests at this point, which will help us identify how best to proceed. All appointments are 45 minutes in length.
It is usually possible to complete all the necessary investigations on the day of the first appointment. This is particularly important for couples travelling long distances.
We also arrange for DNA fragmentation studies to assess sperm quality; these are sent straight to the laboratory for analysis.
A follow-up consultation to review the results of the initial clinical examination and any diagnostic tests will normally take place 2 or 3 weeks after your first visit.
If we've managed to conclude that there is a male factor at play, then further tests may establish whether the problem is reduced sperm production and quality, or an absence of sperm in the ejaculate.
Partners are welcome to attend all consultations but should always attend the second (or follow-up) consultation, when decisions can be taken on the basis of results of our investigations.
“Following the positive results of my FNA procedure, I went for a private semen analysis yesterday evening, which came back as positive for sperm in my semen.”
Fine Needle Aspiration
“My husband saw Mr Ramsay due to fertility issues. He was commenced on Tamoxifen 20mg once a day which was then reduced to every second day due to his bloods. We went on to have successful ICSI treatment and our daughter has now been born”
Our daughter has now been born
“Following our appointment, in which you shared the excellent news regarding the improvement in Ross' DNA fragmentation, we embarked on our third ICSI cycle. I am now 15 weeks pregnant with 2 reassuring scans under our belt. ”
Our third ICSI cycle
“Andrew and I saw you a few times last year when you diagnosed and treated Andy's varicocele. Earlier this year, we had an unsuccessful (2nd) IVF ICSO attempt and were preparing for our 3rd when we discovered I had fallen pregnant naturally in March. I am very pleased to let you know that I am now nearly 11 weeks pregnant! ”
I am now 11 weeks pregnant!
“I am delighted to be writing to tell you that our beautiful baby girl was born on 20th January. You may remember we saw you around this time last year after we had a DNA fragmentation result of 98% and were referred to you. ”
Our beautiful baby girl
“Dear Mr Ramsay, early days yet but we were due to see you this month to look again and see how he's getting on with the meds you prescribed. However, I found out that I'm about 5 weeks pregnant. I literally can't believe it! After 4 years of being told 'you can't have children' and after a round of failed IVF, 2 months of your help and I'm pregnant. Naturally too!”
Im Pregnant. Naturally!