The Hewitt Fertility Centre Leaflets

The leaflet is detailed below, or you can download the 'Surgical Sperm Retrieval (SSR)' leaflet in PDF.

Why do I need surgical sperm retrieval?

Surgical sperm retrieval (SSR) is a treatment option for men who have no sperm (Azoospermia) in their ejaculate. Reasons for undertaking (SSR) could include:

Obstructive Azoospermia – An obstruction preventing sperm release from the testicle due to previous injury or infection, or Congenital Absence of the Vas Deferens (tube carrying sperm from testis) in men with Cystic Fibrosis, or Vasectomy.

Non-obstructive Azoospermia – Likely testicular failure where the testicles are producing low numbers of sperm which are not found in the ejaculate. This could be also associated with genetic conditions.

Other possible clinical indications may be for men with erectile dysfunction and retrograde ejaculation.

What are the different techniques of SSR?

There are different methods of SSR. The cause of your Azoospermia will determine the best way to retrieve sperm in your individual case.

• TESE (Testicular Sperm Extraction). This is often done under general anaesthetic. There is an 0.5cm skin incision. A small incision is made into the testis itself. A small sample of the testicular tissue is taken which is then examined for sperm. (Usually carried out if the male hormone levels and testicular size are normal).
• Micro- TESE (Microscopic Testicular Sperm Extraction). This requires a general anaesthetic and involves performing a 2-3 cm incision on the scrotal skin. The testis is opened and several biopsies are taken from each testicle in different areas and by using an operating microscope, some of the fine individual sperm producing tubes are removed for detailed assessment. The sample is then transported to the Andrology department by a responsible adult of patient’s choice to the Hewitt Fertility Centre for detailed examination, and storage of sperm if found.

How long will I be in hospital?

SSR is a day case procedure.  When done under general anaesthetic, it usually takes 3-4 hours to recover and then you are discharged home. The material collected will be examined on the same day – or cultured in medium and processed – by the embryology team to see if there is any sperm present. Any material with sperm will be frozen (cryopreserved) and placed in storage to be used in In Vitro-Fertilisation / Intra-Cytoplasmic Sperm Injection (IVF-ICSI) assisted reproduction treatment cycle(s) at a later stage. These specimens are then thawed and used to inject the eggs obtained during IVF treatment using the technique of ICSI.

What will happen after the procedure?

Potential side effects post procedure may be some testicular discomfort & mild bruising.

The sedation or anaesthetic will wear off following the procedure; however a responsible adult of patient’s choice will need to drive you home. You should try to have a relative stay with you for the first 24 hours after surgery.

You will need to rest until the effects of the anaesthetic/sedation have passed. Your scrotum will feel sore as the anaesthetic wears off and you may need painkillers.

You will be wearing supportive underwear from the day of procedure and scrotal support (jock strap) daily for a further 5-6 days to minimise discomfort and protect your scrotum and testes.

If you need pain relief, you can take over-the-counter painkillers such as Paracetamol or Ibuprofen.

Showering is advised; try to avoid hot baths to prevent infection. Dissolvable sutures take about 2 weeks to come away.

Avoid Alcohol for 48 hours post-surgery

Refrain from strenuous exercise/lifting for four weeks.

There are no stiches that need to be removed.

Sexual activity is not advised for a week after the procedure.

During the procedure you will be given antibiotics.

Are there any complications?

SSR is a relatively low risk procedure.

Most men do not experience side effects.

However, possible complications include bruising, haematoma (collection of blood in scrotum), minimal scarring and infection. Damage to blood vessels - this can cause permanent damage to one or both testicles (testicular atrophy - rare). Long-term testicular pain (5-10%) - this is caused by damaged nerves or scarring and may require long term pain medication.

Anaesthetic side effects

These include postoperative nausea and vomiting (usually lasts for 1-2 hours and can be controlled with anti-emetic medications). Very rarely anaphylaxis, a severe reaction, (risk is 1 in 10,000).

How effective is SSR?

Obstructive cases are usually more successful than Non-Obstructive.

The sperm which is successfully retrieved is frozen and this does not affect its ability to subsequently fertilise an egg. However the sperm retrieved is usually low in numbers and may not be mature therefore cannot successfully fertilise an egg using standard IVF. Because of this, the embryologist will pick out a single sperm to inject into each egg, (this procedure is called Intracytoplasmic Sperm Injection or ICSI).

References

British Association of Urological Surgeons (2017). BAUS: Surgical sperm retrieval patient information leaflet. Leaflet No: 16/045. Available online: 

https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/Sperm%20retrieval.pdf

NHS England (2016).Clinical Commissioning Policy: Surgical sperm retrieval for male infertility. Available online: https://www.england.nhs.uk/wp-content/uploads/2018/07/Surgical-sperm-retrieval-for-male-infertility.pdf

Shah, R. and Gupta, C. (2018). Advances in sperm retrieval techniques in azoospermic men: a systematic review. Arab Journal of Urology. 16(1): P125-131.

The leaflet is detailed below, or you can download the 'Endometrial Receptivity (ERA), Endometrial Microbiome (EMMA) and Analysis of Chronic Endometritis (ALICE)' leaflet in PDF

Background

Infertility affects 10-15% of couples in the UK, requiring them to proceed with assisted reproduction technology. Despite the recent advances in these techniques, only 1 in 4 attempted IVF cycles results in a baby and only 50% of women under the age of 35 achieve a clinical pregnancy after having a blastocyst transfer.

 Repeated Implantation Failure (RIF)

RIF is determined when transferred embryos do not implant after several attempts. RIF or reduced endometrial receptivity¹ may be caused by:

• Underlying problems in the eggs or sperm
• Underlying problems in the embryos
• Underlying problems in the uterus lining
• Unknown reasons

A number of tests may be used to understand why embryos do not implant. The tests are not guaranteed to give conclusive results. Results from randomised controlled trials assessing the usefulness of these tests are not yet available.

The “endometrial health pack” by Igenomix (Spain) was recently presented at a medical conference as a way of testing RIF. This test consists of an endometrial biopsy that is sent for specific testing.

What tests do we offer?

The ERA test of implantation receptivity challenges the notion that the implantation window is the same for all patients and that for some, replacing an embryo either a day earlier or later may be associated with better results. This would only be appropriate for IVF patients who have a history of RIF. The ERA test is not suitable for patients who experience recurrent miscarriages after natural conception.

The EMMA test looks at the endometrial microbiome and determines the healthy bacteria levels that may play a role in embryo implantation. Probiotic treatment may be suggested to balance the endometrial flora with the aim of improving chance of pregnancy.

The ALICE test looks for 8 bacteria that are potentially harmful to an implanting embryo for which antibiotic intervention may be advised.

These tests are considered to be experimental and are offered at a non-profit price to patients.

Costs

Endome Trio £995 (all three tests)

ERA endometrial receptivity £795

EMMA (microbiome) + ALICE (endometritis) £595

ALICE (endometritis) £395

*The stated price for each treatment may incur an extra cost if more medication is required.

What is required?

Once the decision has been made with your doctor to undertake this test, an endometrial biopsy is taken between Day 15 and Day 25 of the cycle. It may be necessary to prepare the womb lining with a combination of oral oestrogen tablets and vaginal progesterone pessaries for the biopsy. 

An endometrial biopsy is taken by passing a catheter through the cervix and lightly suctioning the endometrial tissue using gentle catheter pressure. The biopsy sample is deposited in a tube and transported to Igenomix for testing. The test results are usually available after 3-4 weeks. A suggested management plan to correct any imbalance is provided. Igenomix analysis of repeat testing is 20% cheaper for further tests. The cost of the procedure by our clinic also still applies.

The ERA test needs to replicate as closely as possible the planned embryo transfer process, especially in relation to duration of progesterone exposure. We have found through several audits that natural frozen embryo transfers have an increased pregnancy rate and lower miscarriage rate than medicated, however those with irregular cycles and erratic ovulation require a medicated approach. Progesterone is a hormone released gradually after ovulation. Duration of progesterone exposure is important for implantation and the ERA test. For natural FET we ask you to phone with a morning LH surge and the embryo transfer is 6 days later. However, natural ovulation is harder to exactly pin point, so if natural FET is planned you need to be aware of this pragmatic interpretation of the ERA result and timing of your embryo transfer. Taking an HCG ‘trigger’ injection does force ovulation, but the hormone profile is a sharp spike, rather than a physiologically gradual rise and fall. Medicated approach (using oestrogen and progesterone) is more controlled but has the disadvantages stated earlier. So, it is important to discuss the planned future techniques for your embryo transfer with the clinic staff. Precise timing for EMMA and ALICE is less important, but should ideally be done as described above.

Are there any risks?

The biopsy procedure is uncomfortable and you may experience some discomfort and very mild vaginal bleeding after the procedure. There is a very rare chance of developing an infection. If you develop a high temperature within a few days of the procedure, experience severe cramping, or unusual bleeding (not just spotting), or offensive vaginal discharge, or are concerned at any time, please contact the Hewitt Centre for further advice. There is also a small chance that the procedure gets abandoned due to difficult entry.

These tests are described as ‘add-on’ treatments. For more information on treatment add-ons, please refer to the HFEA website:

https://www.hfea.gov.uk/treatments/explore-all-treatments/treatment-add-ons/

Please discuss the current HFEA traffic light status for this treatment with your fertility specialist.

If you are unsure whether you should have any of these tests performed please contact the Hewitt Fertility Centre.

References

1. Das M, Holzer HE. Recurrent implantation failure: gamete and embryo factors. Fertil Steril 2012;97(5): 1021

The Hewitt Fertility Centre                                                 

Crown Street

Liverpool

L8 7SS

Tel: 0151 702 4121 / 4123

Email: Hewitt.Centre@lwh.nhs.uk

4 The Pavilions

Knutsford Business Park
Mobberley Road
Knutsford
WA16 8ZR

Tel: 01565 653287

The leaflet is detailed below, or you can download ICSI leaflet in PDF (opens in a new window)

Background

Intra-cytoplasmic sperm injection (ICSI) is a technique, introduced in 1992 to help certain types of infertility. Thousands of couples have become parents as a result of ICSI. It involves the injection of a single sperm directly into the centre of an egg to fertilise it. This procedure bypasses the natural process of the sperm travelling to the egg on its own.

What is the difference between IVF and ICSI?

ICSI is very similar to IVF, with the same process for egg collection. The difference is in the process of insemination. Instead of the sperm being mixed with the eggs as in IVF, with ICSI, a single sperm is injected directly into each egg, with a highly trained embryologist having selected the sperm that are most active and healthy. ICSI allows the use of sperm that may not otherwise have been able to fertilise an egg.

Are there any risks associated with ICSI?

Risks associated with ICSI include the potential for damage to a small number of eggs as they are prepared for the procedure, and also through the process of injection.

ICSI has previously been linked with certain genetic and developmental defects in a very small number of children born using this treatment. However, it is difficult to determine whether this is a result of the ICSI procedure or the underlying cause of infertility. Follow up studies from children born using this technique are still on-going. Another issue to consider is the possibility that if your child conceived as a result of ICSI is a boy, he may inherit his father’s infertility. At this stage it is too early to know if this is the case.

It is important that you discuss possible risks with your doctor before going ahead with treatment. You may also find it helpful to discuss your concerns with a counsellor.

How could ICSI help me?

ICSI could be helpful if the male has: 

• Low sperm count (oligozoospermia).
• Abnormal sperm shape (poor morphology).
• Sperm have poor swimming ability (poor asthenozoospermia).
• Sperm cannot bind or penetrate the eggs for an unknown reason.
• Tubes carrying sperm from the testicles to the penis (vas deferens) are damaged or missing.
• Previous failed or low fertilisation.
• Immune system adverse reaction to sperm (anti-sperm antibodies).
• Failed reversed vasectomy. Testicular sperm extraction (TESE) may be required to obtain sperm. For more information about TESE and what it involves, and whether these may be options for you, please speak to your doctor.
• Difficulty obtaining an erection or achieving ejaculation. This particularly affects men who have spinal cord injuries, Hodgkin’s disease and numerous other disorders.

What are my chances of having a baby with ICSI?

The chances of having a baby using ICSI are similar to those for IVF. As with most fertility treatment, success depends on many factors including female age.

For up-to-date information and access to recent patient experiences using ICSI, please use the following link to access the HFEA website:

https://www.hfea.gov.uk/treatments/explore-all-treatments/intracytoplasmic-sperm-injection-icsi/

The leaflet is detailed below, or you can download the 'Transgender & Non-Binary Fertility Preservation - Egg Freezing' leaflet in PDF.

Why should I think about fertility preservation?

Future fertility may be something you are thinking about as a transgender or non-binary person.  Understandably, some transgender and non-binary people are keen to start hormone therapy or have surgery as quickly as possible. However, you may find it a source of regret if you realise later that it is not possible, or more difficult, to have a biological family. Thinking through all these issues now and understanding your options will help you to make an informed decision.

Some medical treatments for gender dysphoria, including hormone therapy and surgery, can have a temporary or permanent impact on your fertility. If you are considering starting treatment to physically alter your body, or you have already started, you can contact us to discuss possible options for preserving your fertility.

Having genital reconstructive surgery can prevent you from having biological children without the use of a surrogate or interventional fertility treatments. Genital surgery that may be considered includes salpingo-oophorectomy (removal of the fallopian tubes and ovaries) and/or hysterectomy (removal of the womb). How you decide to preserve your fertility would be dependent on your particular situation. You may wish to preserve your fertility by having your eggs frozen or by creating and freezing embryos. If you are interested in embryo freezing, please find more information on this process in our leaflet titled ‘Embryo Freezing and Thawing Patient Information’

How are eggs collected and stored?

You will be assessed by a clinician before undergoing fertility preservation treatment, most likely by way of an ultrasound examination. If you are concerned about being examined, please contact the clinic to discuss how we can make this more comfortable for you. You will also need to have blood tests to determine your hormone levels in addition to viral screening (minimum requirement: Hepatitis B, Hepatitis C and HIV).

In the future, you may decide to have IVF treatment using a surrogate and your frozen eggs. For this reason, the clinical team may recommend that you undergo extended screening tests prior to freezing your eggs. If you decide to go ahead with IVF treatment using a surrogate, you may then be required to undergo further extended screening tests at that time; these tests may incur a further cost.

Fertility drugs are given to stimulate the ovaries to produce several follicles that contain eggs (please see the leaflet “Ovarian Stimulation”). The development of follicles is monitored by vaginal ultrasound scans. When the follicles have reached the right size, the eggs are collected by a practitioner using a needle at the end of the ultrasound probe under direct vision, to remove the fluid within the follicles. The fluid is assessed under a microscope; any eggs present are identified by the embryologist and placed into an incubator until they are frozen. It is important to note that not all the eggs may be suitable for freezing; only mature eggs will be frozen. Regarding the egg freezing process, mature eggs are mixed with cryoprotectant (a solution that protects the eggs from very cold temperatures) and placed in straws before submersion in liquid nitrogen. Egg freezing is a technique that allows long-term egg storage in very cold conditions (-196°C).

How long can eggs be stored?

Eggs can be stored for up to 55 years; however the storage period will be renewed every 10 years. You are free to withdraw or vary the terms of your consent at any time.

I’ve already started my transitioning medication, what are my options?

If you have already started hormone therapy or you are taking puberty suppressing medication, you will need to discuss your future options with a clinician. They may recommend that you stop taking your medication to increase your chance of having a family through assisted family treatment. We understand that it can be distressing to come off hormone therapy, so there will be no pressure from the clinic to do this.

Some transgender and non-binary people may also consider other options for having a family, such as the use of donated eggs, sperm or embryos in treatment or adoption. Done in the right way, using a donor is a safe and increasingly common way of creating a family. If you’re interested, please ask The Hewitt Fertility Centre for further advice and the relevant patient information leaflets.

What happens when I want to use my frozen eggs?

The use of your frozen eggs is dependent on your individual situation; this may involve your partner, using a surrogate, using donor sperm or if you have not had your uterus removed, the option of carrying the pregnancy yourself may exist.

Once you are ready to proceed with treatment, the eggs are removed from storage and thawed. Not all eggs survive the freezing/thawing process. Current data from the Hewitt Fertility Centre shows that 77% of eggs survive the process (this data was collected from patients of all ages between the years 2013 - 2018).

Suitable eggs are inseminated with sperm using a technique known as Intracytoplasmic Sperm Injection (ICSI). ICSI is required because frozen-thawed eggs no longer have their protective outer cell coating. Conventional IVF cannot be performed, as for this method, the outer cell coating is necessary for sperm to achieve fertilisation.

What are the success rates?

Until recently, pregnancy rates from egg freezing procedures were very poor, but scientific advances have now made egg freezing a viable option. However, the data is still limited and as with all fertility treatments, there is no guarantee this procedure will result in a successful pregnancy. It is also important to remember that some cycles may be cancelled prior to embryo transfer due to poor egg survival, failed fertilisation or poor embryo development.

Are there any risks associated with egg freezing?

Although current data indicate that there are no increases in birth defects or chromosomal abnormalities in children born from frozen eggs, we still need to monitor this carefully as we collect more data. It is important to note that many healthy babies have been born following egg freezing/thawing; but as this is still a relatively new procedure, there may be some yet unrecognised risks.

Do I have to pay for freezing & storing my eggs?

Funding for egg freezing for gender reassignment prior to future IVF/ICSI treatment is dependent upon the NHS clinical commissioning group that you fall under and your specific circumstances. You will need to contact your GP to investigate your funding options. If you are eligible for NHS funded storage, it is important to note that when this is due to end, you will be contacted by The Hewitt Fertility Centre to ask whether you wish to continue storage. Continued storage after this period, will incur an annual fee (approximately £180 per year).

If you are not pursuing NHS funding for any aspect of your treatment, you can contact the clinic directly for more information on treatment costs.

Safety & Quality

We promise to look after your eggs as carefully as possible, but we cannot be held responsible for egg safety or the risk of the loss of eggs due to accident or equipment failure. In addition, we cannot guarantee that your eggs will survive the warming process or that a successful pregnancy will result from their use.

Contact with the unit

You must keep us informed of any change in your circumstances e.g. change of address. This is because, we will contact you in the future to see if you still want your eggs to be stored. If we are unable to contact you, your samples will be destroyed when they reach the end of their statutory storage period. If you have any questions on egg storage, please contact the unit and ask to speak to a member of the Embryology team.

Hewitt Fertility Centre - Liverpool               

Crown Street                                            

Liverpool                                    

L8 7SS

Tel: 0151 702 4121 / 4123

Email: Hewitt.Centre@lwh.nhs.uk 

Hewitt Fertility Centre - Knutsford                          

4 The Pavilions,

Knutsford Business Park,
Mobberley Road

Knutsford
WA16 8ZR

Tel: 01565 653287

Email: Hewitt.Centre@lwh.nhs.uk

The leaflet is detailed below, or you can download the 'Transgender & Non-Binary Fertility Preservation - Sperm Freezing' leaflet in PDF.

Why is it a good idea to freeze sperm?

Future fertility may be something you are thinking about as a transgender or non-binary person. Understandably, some transgender and non-binary people are keen to start hormone therapy or have surgery as quickly as possible. However, you may find it a source of regret if you realise later that it is not possible, or more difficult, to have a biological family. Thinking through all these issues now and understanding your options will help you to make an informed decision. Before any of these procedures are carried out, it is possible to store sperm using a freezing process known as cryopreservation.  

Some medical treatments for gender dysphoria or incongruence, including hormone therapy and surgery, can have a temporary or permanent impact on your fertility. If you are considering starting treatment to physically alter your body, or you have already started, you can contact us to discuss possible options for preserving your fertility.

What is the procedure for freezing sperm?

Once referred, The Hewitt Fertility Centre will telephone you to arrange an appointment to visit the centre and store your sperm. If possible, this appointment should be made before the gender reassignment treatment is due to begin.

Firstly, you will have a consultation with a member of staff to discuss the implications of storing your sperm and discuss the relevant consent forms. You will be asked questions with regards to the storage and use of stored samples. It may be useful (before your appointment) to consider, if you have a partner, whether you would like them to be able to use your stored samples in the future. At this appointment, you will also have the opportunity to ask any questions.

In order to store your sperm, you will require a blood test to screen for HIV, Hepatitis B & C; this is a legal requirement due to the theoretical risk of viral cross-contamination between samples.

You will then be asked to produce a semen sample. The centre has private, specially designed, sound-proof production rooms available in which you can produce your sample. In some circumstances, it may be possible to produce your sample at home, provided it is delivered to the centre within one hour.

What happens to my sperm once I’ve produced a sample?

Once you have produced your sample, a semen analysis test will be done to quantify the quality of the sample. If your sample is unsuitable for storage, additional tests may be required to understand why; if this occurs you can discuss your next steps and future options with your clinician.

Your sample will then have cryoprotectant added (a liquid that prevents damage to sperm cells during freezing) before being stored in a number of sperm straws. The straws are gradually cooled to -196°C. Once cooled, your sample will be placed into special containers called dewars, where they will be kept in liquid nitrogen vapour until you require them for fertility treatment, or no longer need them.

How many samples will I need to produce?

On average, three samples will be sufficient to safeguard future fertility options; however, the clinic will guide you on whether you need to produce more or less.

What are the legal implications for storing sperm?

All fertility centres fall under the regulation of the Human Fertilisation and Embryology Authority (HFEA). Prior to freezing and storing sperm, it is a legal requirement that you give written consent concerning;

• Storage of your sperm and the length to which it is stored for
• The circumstances to which your sperm can be used in the future (you may have a partner with whom you wish to have a family named on your form)
• Your decision over any embryos created using your sperm
• What happens to your frozen sperm in the event of your death or incapacitation
• What will happen if your sperm is not used

You should be aware that in the event of your death, you can have your name registered as the parent of any child or children born as a result of using your sperm, provided you have consented to this in writing. If your circumstances change, for instance you move address, change telephone number, or separate from your partner at the time of storage, it is vitally important that you make the Hewitt Fertility Centre aware of these changes immediately. This is because we will contact you to ask if you still want your sperm to be stored. If we are unable to contact you, your samples will be destroyed when they reach the end of their statutory storage period. If you have any questions on sperm storage, please contact the unit and ask to speak to a member of the Andrology team.

I’ve already started my transitioning medication, what are my options?

If you have already started hormone therapy or you are taking puberty suppressing medication, you will need to discuss your future options with a clinician. They may recommend that you stop taking your medication to increase your chance of having a family through assisted family treatment. We understand that it can be distressing to come off hormone therapy, so there will be no pressure from the clinic to do this.

Some transgender and non-binary people may also consider other options for having a family, such as the use of donated eggs, sperm or embryos in treatment or adoption. Done in the right way, using a donor is a safe and increasingly common way of creating a family. If you’re interested, please ask The Hewitt Fertility Centre for further advice and the relevant patient information leaflets.

How long can sperm be stored?

Sperm can be stored for up to 55 years; however, the storage period will be renewed every 10 years. You are free to withdraw or vary the terms of your consent at any time.

Do I have to pay for freezing & storage of my sperm?

Sperm freezing funding for gender reassignment is dependent upon the NHS clinical commissioning group that you fall under and your specific circumstances.

If NHS funding is available for you, when your funded storage period ends, you will be contacted by the Hewitt Fertility Centre to ask whether you wish to continue storage. Continued storage after this period will incur an annual fee (approximately £180 per year)

In the future, you may decide to have IVF treatment using a surrogate and your frozen sperm. For this reason, the clinical team may recommend that you undergo extended screening tests prior to freezing your sperm. In the future, if you decide to go ahead with this IVF treatment, you may then be required to undergo further extended screening tests at that time; these tests may incur a further cost.

If you are not pursuing NHS funding for any aspect of your treatment, you can contact the clinic directly for more information on treatment costs.

What are the risks of sperm freezing?

It is well established that a number of sperm can either be damaged or do not survive the freezing process. It is also clear that success depends on the quality of the initial sperm sample; frozen samples with reduced numbers of sperm or high rates of sperm abnormalities are less likely to be successful in treatment. However, it must be noted that treatment with frozen sperm is currently just as successful as treatment using fresh sperm (HFEA, 2021).

Safety & Quality

We promise to look after your sperm as carefully as possible, but we cannot be held responsible for its safety or the risk of the loss of sperm due to accident or equipment failure. In addition, we cannot guarantee your sperm will survive the freeze-thaw process or that a successful pregnancy will result from its use.

The Lewis-Jones Andrology Department at the Hewitt Fertility Centre has provided a dedicated Andrology service for over 30 years. We are attached to the Hewitt Fertility Centre HFEA licenced centre 0007) and can provide all fertility treatments potentially required in the future. We also have a centre at Knutsford (Centre number 0344) where the same care can be provided if more convenient and appropriate.

Contact with the unit

Please feel free to contact the laboratory on 0151 702 4214 or email lwft.andrologylab@nhs.net if you require any further information about fertility preservation.

The Lewis-Jones Andrology Department,

The Hewitt Fertility Centre

Crown Street

Liverpool

L8 7SS

Tel: 0151 702 4214

Email: lwft.andrologylab@nhs.net

4 The Pavilions

Knutsford Business Park
Mobberley Road
Knutsford
WA16 8ZR

Tel: 01565 653287

Email: lwft.andrologylab@nhs.net

The leaflet is detailed below, or you can download the 'Screening Clinic' leaflet in PDF

It is natural to feel apprehensive before attending your appointment we hope this leaflet will explain what to expect.

What to expect at your appointment?

This appointment is for you and your partner (if you have one), it is very important that your partner (if you have one) attends this appointment so you are both aware of the tests that are required and so a medical history can be obtained from you both.

The appointment will last approximately 1 hour

Be prepared to answer questions

In order to provide an in-depth medical history it’s important to be open and honest even though you may feel a little embarrassed.

• Please bring a list of medication that you are both taking (if applicable)
• We will need to ask you how long you have been trying to get pregnant, how often you have sexual intercourse and if there are any difficulties.
• We need to ask If you have had any previous pregnancies (including miscarriages and termination of pregnancy)
• We will ask about your past medical history
• We will ask about your lifestyle including: smoking; recreational drugs and alcohol intake.

 Common Fertility Tests/ Screening

During your appointment you will see one of our Sonographers/ Nurse Sonographers and a Transvaginal Ultrasound Scan will be performed.

This is where an internal scan probe is inserted into the vagina. This gives a very clear view of the womb and ovaries. An Antral-Follicle Count will be performed, Antral follicles are ovarian follicles that still contain immature eggs. If the ultrasound reveals very few antral follicles, it is an indicator of fewer eggs remaining. The antral follicles reduce with an increase in a woman’s age.

The sonographer will write a report about the findings which will be discussed with you at your next appointment.

During your appointment you will also see another member of the team who will organise/ obtain further tests, including blood tests.  They will also check your BMI (this is a value derived from ratio of height and weight).

Tests for Woman.

Rubella immunity screening- this is a blood test to ensure you have immunity to Rubella (German Measles), Rubella can be very serious if a pregnant woman catches it in the early stages of pregnancy.

Anti-Mullerian Hormone (AMH) - is produced by small follicles (pouches which contain the eggs) growing in the ovary. It can be measured in a blood test. The level of AMH reflects how many follicles are growing, which gives an indication of how many eggs are present in the ovary. The number of eggs present in the ovary declines as we age, until the menopause, when the supply runs out. The more follicles that are growing, the higher the level of AMH in the blood. This test is interpreted alongside the Antral Follicle Count scan.

Progesterone - this is a blood test to check if you are ovulating.

Chlamydia Screening- Chlamydia is a sexually transmitted infection that can affect fertility; a urine sample is obtained to detect this.

Tests for Men

Semen Analysis- It is important that a semen analysis (within the last year) has been performed. This is to check if there are any problems with your sperm. An appointment will be organised so that the sample can either be produced at home and brought to the andrology section of the unit or produced on site.

A further information leaflet will be given about this.

Blood tests- Occasionally hormone blood tests may need to be performed.

What your appointment is not

• This appointment is not to check about your eligibility for NHS fertility treatment. That will be checked by a separate office within the hospital based on your CCG and individual circumstances.
• The appointment is not to give results of any previous investigations, it is a screening clinic to instigate investigations.

Next Steps

After your appointment a follow- up appointment will be made with a clinician to discuss your results of the tests performed and next steps. This is usually via a telephone consultation.

Occasionally (depending on your individual history) a test to check the patency of fallopian tubes is made for the woman.

Hysterosalpingo-contrast-sonography test (a Hycosy test) is arranged. This is a procedure using advanced ultrasound to test for common symptoms such as blocked fallopian tubes. A contrast agent is passed into the uterus via a fine catheter and the sonographer tracks this agent using ultrasound. If this test needs to be performed it will be carried out prior to your follow up appointment so that all your results can be given altogether.

Lifestyle

Stop Smoking- Smoking has been linked to infertility and early menopause in women and has been shown to reduce sperm quality in men. It is also a factor in premature or low birth-weight babies. It may also affect your eligibility for NHS funding for fertility treatment.

A balanced healthy diet is important for your general health as well as fertility. It’s important to aim for a BMI less than 30 (more than 30 may affect your NHS funding eligibility criteria)

www.nhs.uk/livewell/goodfood/pages/goodfoodhome

Folic Acid is important to help your unborn baby's brain, skull and spinal cord develop properly to avoid development problems (called neural tube defects) such as spina bifida. Women should take this before getting pregnant and continue up to your 12th week of pregnancy. You are also advised to take Vitamin D daily.

www.nhs.uk/medicines/folic-acid/

Alcohol- the safest approach is not to drink alcohol at all to keep risks to your baby to a minimum. Drinking too much alcohol can also affect the quality of sperm (UK Chief Medical Officers recommend adults should drink no more than 14 units of alcohol a week, which should be spread evenly over 3 days or more)

Useful Info

www.nhs.uk

www.hfea.gov.uk

The leaflet is detailed below or you can download the 'Diagnostic Semen Analysis' leaflet in PDF

What is semen analysis?

Semen analysis is the gold-standard test performed to assess the fertility potential of a male. Several important parameters are measured which include semen volume, sperm concentration, sperm motility and sperm shape. All parameters are compared to reference ranges set by the World Health Organisation (WHO).

The total number of spermatozoa per ejaculate, sperm concentration and the extent of progressive sperm motility are related to pregnancy rates. Motility assessment is usually performed using computer-aided sperm analysis (CASA).

How do I get an appointment?

Once you have been referred to us by a clinician you will be able to book in for your appointment online using the NHS e-Referral service. After you have booked in, we will send you out a pack to the address provided to us. This pack will contain instructions, a production form and sample pot. These instructions must be read in advance of your appointment.

If you have any questions, please contact the laboratory on 0151 702 4214.

We are unable to accept any samples without an appointment.

How can I produce the sample?

Samples should be collected by masturbation. Do not produce your sample using lubricants, condoms or through the withdrawal method. If you are unable to ejaculate by masturbation, special condoms for use at home may be provided in exceptional circumstances. However, the entire ejaculate will not be available for examination, and the specimen is likely to be contaminated by contact with the skin of the penis and to some extent also vaginal fluid and cells on the outside of the condom.

How do I collect the sample?

• In order to obtain an optimum sample you are required to abstain from any sexual activity (masturbation or intercourse) before your appointment. Please ejaculate 4 days before your appointment and then again 2 days before your appointment. Do not ejaculate again until you are producing your sample for analysis.
• Produce your sample by masturbation into the non-toxic sterile pot provided in your pack. Your pot must be labelled with your name, DOB and hospital identification number.
• Please do not attempt to produce your sample into any other type of specimen pot.
• Please ensure you attempt to collect all of the semen produced.
• Once the sample has been collected please ensure the lid is screwed on tightly and place the pot inside the sealable bag provided.
• Ensure you bring the fully completed request form with you to the hospital. We cannot accept your sample until this has been completed correctly.
• The pot must not be exposed to extremes of temperature either before or after sample production. If you are concerned about this, please speak to a member of staff.

Where can I produce the sample?

You may produce your sample at home if you can deliver it to the laboratory at your allotted appointment time preferably within 30 minutes after collection and at least no longer than 50 minutes after collection. Whilst travelling from home it is important you keep the sample close to the body under clothes during transportation (for example, in a pocket) as sperm are sensitive to extremes of temperature. If preferable, your partner may deliver your sample and completed production form.

If you cannot deliver your sample to the laboratory within 50 minutes of ejaculation or would rather produce your sample on site, we have private, sound-proof production rooms available for use.

Where do I need to go?

Your chosen appointment location will be listed in your semen analysis pack.

Liverpool – The Lewis-Jones Andrology Department at the Liverpool Women’s Hospital (L8 7SS) is situated on the second floor. Please follow signs for the Hewitt Fertility Centre and our waiting room is situated next door.

Knutsford – The Andrology laboratory is situated on the ground floor of The Hewitt Fertility Centre, Knutsford (WA16 8ZR). Upon arrival please report to reception and a member of staff will be able to assist you.

Ormskirk – The Seminology laboratory is located within the Gynaecology and Maternity department at Ormskirk District General Hospital (L39 2AZ). From the main entrance of the hospital please continue two thirds of the way up through the main corridor and turn right.

How do I get my results?

Your results will be sent back to your referring clinician approximately 14 days after your semen analysis. Unfortunately, these results cannot be given to you by our laboratory staff.

Repeat tests

If you cannot produce your sample or have an incomplete collection you will be asked to repeat the test after a further 2 days abstinence. If one or more of your sperm parameters are reported below the lower fifth percentile (WHO 2021) your clinician may request you repeat the test. This is to ensure your results are representative of a typical ejaculate.

What if I have a poor result?

Discovering you have a poor result may come as a shock and leave you feeling anxious. We have counsellors and patient support groups available at our Liverpool and Knutsford centres if you would like to discuss your feelings relating to this diagnosis.

(https://www.thehewittfertilitycentre.org.uk/support-and-advice/) You should always bear in mind that advances in fertility treatment mean that you may still be able to conceive. You can discuss your options and next steps with your clinician.

Research and waste

The portion of your sample that is left over after diagnostic semen analysis is disposed of by incineration. It will not be stored for treatment purposes. In some cases, it may be used by us for training or research.

Queries

Please feel free to contact the laboratory on 0151 702 4214 if you require any further information about this test.

Quality

The Lewis-Jones Andrology department at the Hewitt Fertility Centre has provided a dedicated Andrology service for over 10 years. We were the first Andrology laboratory to be accredited for quality and competence by the UK Accreditation Scheme (UKAS). Our laboratory is also enrolled in the UK National External Quality Assurance Scheme (UK NEQAS) which helps to ensure clinical laboratory test results are accurate, reliable and comparable wherever they are produced.

Feedback

If you need advice or are concerned about any aspect of your care or treatment please speak to a member of staff. After your appointment you may receive a text message asking you to complete a survey about our service. We appreciate and encourage feedback.

The Lewis-Jones Andrology Department,

Hewitt Fertility Centre,

Liverpool Women’s Hospital

Crown Street,

L8 7SS

0151 702 4214

https://www.thehewittfertilitycentre.org.uk

The leaflet is detailed below, or you can download the 'Diagnostic Semen Analysis (Leighton)' leaflet in PDF

What is semen analysis?

Semen analysis is the gold-standard test performed to assess the fertility potential of a male. Several important parameters are measured which include semen volume, sperm concentration, sperm motility and sperm shape. All parameters are compared to reference ranges set by the World Health Organisation (WHO).

The total number of spermatozoa per ejaculate, sperm concentration and the extent of progressive sperm motility are related to pregnancy rates. Motility assessment is usually performed using computer-aided sperm analysis (CASA).

How do I get an appointment?

You will need to be referred to us by a clinician. Once we have received your referral, we will send you out a pack to the address provided to us. This pack will contain instructions, a production form, sample pot and appointment information. These instructions must be read in advance of attempting to produce your sample.

If you cannot make the appointment, we have sent you please contact Ward 25 reception team on 01270 612212 in advance to reschedule. We are unable to accept any samples without an appointment.

How can I produce the sample?

Samples should be collected by masturbation. Do not produce your sample using lubricants, condoms or through the withdrawal method. If you are unable to ejaculate by masturbation, special condoms for use at home may be provided in exceptional circumstances. However, the entire ejaculate will not be available for examination, and the specimen is likely to be contaminated by contact with the skin of the penis and to some extent also vaginal fluid and cells on the outside of the condom.

How do I collect the sample?

• In order to obtain an optimum sample you are required to abstain from any sexual activity (masturbation or intercourse) before your appointment. Please ejaculate 4 days before your appointment and then again 2 days before your appointment. Do not ejaculate again until you are producing your sample for analysis.
• Produce your sample by masturbation into the non-toxic sterile pot provided in your pack. Your pot must be labelled with your name, DOB and hospital identification number.
• Please do not attempt to produce your sample into any other type of specimen pot.
• Please ensure you attempt to collect all of the semen produced.
• Once the sample has been collected please ensure the lid is screwed on tightly and place the pot inside the sealable bag provided.
• Ensure you bring the fully completed request form with you to the hospital. We cannot accept your sample until this has been completed correctly.
• The pot must not be exposed to extremes of temperature either before or after sample production. If you are concerned about this, please speak to a member of staff.

Where can I produce the sample?

You may produce your sample at home if you can deliver it to the laboratory at your allotted appointment time preferably within 30 minutes after collection and at least no longer than 50 minutes after collection. Whilst travelling from home it is important you keep the sample close to the body under clothes during transportation (for example, in a pocket) as sperm are sensitive to extremes of temperature. If preferable, your partner may deliver your sample and completed production form.

If you cannot deliver your sample to the laboratory within 50 minutes of ejaculation or would rather produce your sample on site, we have rooms available for use.

Where do I need to go?

The Andrology laboratory is located within Ward 25 at Mid Cheshire Hospitals NHS Foundation Trust, Leighton hospital (CW1 4QJ). From the Maternity and Women’s services entrance, proceed down the corridor and take the stairs/lift on the left hand side to the 2nd floor. Please report to reception upon arrival.

How do I get my results?

Your results will be sent back to your referring clinician approximately 14 days after your semen analysis. Unfortunately, these results cannot be given to you by our laboratory staff.

Repeat tests

If you cannot produce your sample or have an incomplete collection you will be asked to repeat the test after a further 2 days abstinence. If one or more of your sperm parameters are reported below the lower fifth percentile (WHO 2021) your clinician may request you repeat the test. This is to ensure your results are representative of a typical ejaculate.

What if I have a poor result?

Discovering you have a poor result may come as a shock and leave you feeling anxious. We have counsellors and patient support groups available at our Liverpool and Knutsford centres

if you would like to discuss your feelings relating to this diagnosis (https://www.thehewittfertilitycentre.org.uk/support-and-advice/)

You should always bear in mind that advances in fertility treatment mean that you may still be able to conceive. You can discuss your options and next steps with your clinician.

Research and waste

The portion of your sample that is left over after diagnostic semen analysis is disposed of by incineration. It will not be stored for treatment purposes. In some cases, it may be used by us for training or research.

Queries

Please feel free to contact the Hewitt Andrology service on 0151 702 4214 if you require any further information about this test. PLEASE CONTACT THE WARD 25 RECEPTION TEAM DIRECTLY IF YOU WISH TO CHANGE YOUR DATE/TIME OF APPOINTMENT.

Quality

The Lewis-Jones Andrology department at the Hewitt Fertility Centre has provided a dedicated Andrology service for over 10 years. We were the first Andrology laboratory to be accredited for quality and competence by the UK Accreditation Scheme (UKAS). Our laboratory is also enrolled in the UK National External Quality Assurance Scheme (UK NEQAS) which helps to ensure clinical laboratory test results are accurate, reliable and comparable wherever they are produced.

Feedback

We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff

The Lewis-Jones Andrology Department,

Hewitt Fertility Centre,

Liverpool Women’s Hospital

Crown Street,

L8 7SS

0151 702 4214

https://www.thehewittfertilitycentre.org.uk

The leaflet is detailed below, or you can download the 'Freezing and Storage of Sperm for Fertility Preservation' leaflet in PDF

Why is sperm stored?

Some forms of chemotherapy, radiotherapy, surgery, and hormone therapy can lead to infertility which may be temporary or permanent. Fertility preservation is particularly important for patients undergoing cancer treatment or gender reassignment. Before any of these procedures are carried out, it is possible to store sperm using a freezing process known as cryopreservation.

Sperm samples can also be collected and frozen in the case of a medical condition known as retrograde ejaculation, where the sperm is passed into the bladder instead of passing out through the urethra.

If you have difficulty with or concerns about producing a sperm sample for treatment, you may wish to consider freezing a sample prior to infertility treatment. Please ask a member of staff for further information. Frozen sperm samples can be thawed when required and used in procedures such as artificial insemination (IUI), in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).

How does cancer treatment affect fertility?

Cancer treatments are important for your future health, but they may harm reproductive organs and glands that control fertility. These changes to your fertility may be temporary or permanent.

It is difficult to predict if the cancer treatment will affect your fertility. Whether or not your fertility is affected depends on factors such as:

• baseline fertility
• age at the time of treatment
• type of cancer and type treatment you receive
• other personal health factors

Your doctor will be able to talk with you about whether your cancer treatment is likely to lower your fertility or cause permanent infertility. Your doctor can then refer you to The Hewitt Fertility Centre to produce and store your sperm.

I would like to store my sperm for future use, what happens next?

Once referred, The Hewitt Fertility Centre will telephone you to arrange an appointment date and time to visit the centre and store your sperm. The appointment/s made will be before further treatment is due to begin (gender reassignment, cancer treatment or before IVF treatment).

Firstly, you will have a consultation with a Reproductive Scientist to discuss the implications of storing your sperm and complete the relevant consent forms. You will be asked questions with regards to the storage and use of stored samples. It may be useful before your appointment to consider, if you have a partner, whether you would like them to be able to use your stored samples. Also, at this appointment, you will have the opportunity to ask any questions you might have. Next, you will be asked to produce a semen sample through masturbation. The centre has private, specially designed, sound-proof production rooms available in which you produce your sample. In some circumstances, it may be possible to produce your sample at home, provided it is delivered to the centre within one hour. Finally, you will have a blood test where we screen for HIV, Hepatitis B & C. This is for sperm storage purposes as there is a theoretical risk of viral cross-contamination between samples.

What happens to my sperm once I’ve produced a sample?

Once you have produced your sample, it will undergo a semen analysis test to quantify the quality of the sample. Your sample will then have cryoprotectant added (a liquid media that prevents damage to sperm cells during freezing) before being transferred into a number of ‘sperm straws. The straws are gradually cooled to -196°C. Once cooled, your sample will be placed into special containers called dewars, where they will be kept in liquid nitrogen until you potentially require them for fertility treatment.

Have I produced enough sperm and what is its quality like?

The Hewitt Fertility Centre will ensure that enough of your sperm will be frozen for future fertility treatment/s. This may involve attending the centre up to two further times. We will know whether further appointments will be needed after you have produced your first sample and will arrange this with you if further appointments are required. This is of course dependent upon when your future treatment is due to start. If your sample is unsuitable for storage, you can discuss your options and next steps with your clinician. You are also welcome to use our counselling service if you wish to do so.

What are the legal implications for storing sperm?

All fertility centres are under the regulation of the Human Fertilisation and Embryology Authority (HFEA). Prior to freezing and storing sperm, it is a legal requirement that you give written consent concerning;

• Storage of your sperm and the length to which it is stored for
• The circumstances to which your sperm can be used in the future (you may have a partner with whom you wish to have a family named on your form)
• Your decision over any embryos created using your sperm
• What happens to your frozen sperm in the event of your death or incapacitation
• What will happen if your sperm is not used

You are free to withdraw or vary the terms of your consent at any time. You should be aware that in the event of your death, you can have your name registered as the parent of any child or children born as a result of using your sperm, provided you have consented to this in writing. If your circumstances change, for instance you move address, change telephone number, or separate from your partner at the time of storage, it is vitally important that you make the Hewitt Fertility Centre aware of these changes immediately.

Can I test my fertility once my cancer treatment has finished?

Six months after your cancer treatment has ended, you can contact the centre to arrange for a semen analysis test, along with a follow-up consultation to see a fertility specialist. Here, we will discuss whether your sperm function has returned and your available fertility options in the future.  There is currently no evidence that children conceived naturally of a parent who has had cancer treatment will have an increased risk of abnormalities.

How long can sperm be stored?

In normal cases, sperm may be stored for up to ten years. This storage period can be extended up to 55 years if premature infertility is diagnosed or suspected to occur. A registered medical practitioner has to give a written opinion that the fertility of the person wishing to extend storage is, or is likely to become, significantly impaired. Sperm stored for an extended period can only be used by the person providing the sperm, or together with their partner, it cannot be donated to treat others.

If you wish to continue to store your sperm after the standard ten year period, you must contact us in writing and our senior scientist will assess if there is still a medical ground for you to continue storage.

 Do I have to pay for freezing & storing my sperm?

If you will be undergoing cancer treatment where there is a possibility of it affecting your fertility, funding for the freezing and storage of sperm is typically provided by the NHS for 10 years. This is dependent upon which NHS clinical commissioning group you fall under and what specific criteria they have set for funding sperm storage. When you are referred for fertility preservation, this will be assessed beforehand.

Sperm freezing for gender reassignment and prior to IVF/ICSI treatment is also dependent upon the NHS clinical commissioning group that you fall under and your specific circumstances.

When NHS funding for storage ends, you will be contacted by the Hewitt Fertility Centre to ask whether you wish to continue storage. Continued storage after this period, will incur an annual fee.

Will future fertility treatment be available on the NHS?

After your cancer/gender re-assignment treatment, if you require fertility treatment to achieve a pregnancy, your GP will have to refer you to a fertility centre. 

Your clinical commissioning group will then make an assessment as to whether you and your partner meet the eligibility criteria they have set for NHS funding. If you do not meet these criteria, fertility treatment will have to be self-funded. We cannot guarantee any samples frozen will achieve a pregnancy.

How successful is the use of frozen sperm?

It is clear that success does depend on the quality of the sperm stored. Frozen samples with reduced numbers of sperm or high rates of sperm abnormality are less likely to be successful in treatment. There is always a small reduction in sperm quality due to the freeze-thaw process.

Safety & Quality

 We promise to look after your sperm as carefully as possible but we cannot be held responsible for its safety or the risk of the loss of sperm due to equipment failure. In addition we cannot guarantee your sperm will survive the freeze-thaw process or that a successful pregnancy will result from its use.

The Lewis-Jones Andrology Department at the Hewitt Fertility Centre has provided a dedicated Andrology service for over 30 years. We are attached to the Hewitt Fertility Centre HFEA licenced centre 0007) and can provide all fertility treatments potentially required in the future. We also have a centre at Knutsford (Centre number 0344) where the same care can be provided if more convenient and appropriate.

Contact with the unit

Please feel free to contact the laboratory on 0151 702 4214 or email lwft.andrologylab@nhs.net if you require any further information about fertility preservation.

You must keep us informed of any change in your circumstances e.g. change of address. This is because we will contact you every three years to see if you still want your sperm to be stored. If we are unable to contact you, your samples will be destroyed when they reach the end of their statutory storage period. If you have any questions on sperm storage, please contact the unit and ask to speak to a member of the Andrology team.

The Lewis-Jones Andrology Department,

The Hewitt Fertility Centre

Crown Street

Liverpool

L8 7SS

Tel: 0151 702 4214

Email: lwft.andrologylab@nhs.net

4 The Pavilions

Knutsford Business Park

Mobberley Road

Knutsford

WA16 8ZR

Tel: 01565 653287       

The leaflet is detailed below, or you can download the 'Freezing and Storage of Sperm Prior to Fertility Treatment' leaflet in PDF. 

Why is my sperm sample being frozen?

The Hewitt Fertility Centre will want to make sure they have sperm to use when fertility treatment starts with your partner. Frozen sperm samples can be thawed when required and used in procedures such as artificial insemination (IUI), in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Freezing your semen sample before fertility treatment will help maximise the chance of this being the case.

• Sperm freezing, also known as sperm cryopreservation, is typically offered for the following reasons;
• Some forms of chemotherapy, radiotherapy, surgery, and hormone therapy can lead to infertility which may be temporary or permanent. Fertility preservation is particularly important for patients undergoing cancer treatment or gender reassignment. Before any of these procedures are carried out, it is possible to store sperm using a freezing process known as cryopreservation.
• Sperm samples can also be collected and frozen in the case of a medical condition known as retrograde ejaculation, where the sperm is passed into the bladder instead of passing out through the urethra.
• If you have difficulty with or concerns about producing a sperm sample on the day of treatment.
• If the quality of your sperm sample is such that we have concerns that there may not be an adequate number of sperm to perform your ICSI treatment on the day of egg collection.
• Social reasons. For instance, not being available when your semen sample will be required during fertility treatment.

Please ask a member of staff for further information if you wish to consider freezing a sample prior to infertility treatment.

I’ve been asked to freeze my sperm, what happens next?

If your doctor has recommended sperm freezing, you will first have a blood test where we screen for HIV, Hepatitis B & C. This is for sperm storage purposes as there is a theoretical risk of viral cross-contamination between samples.

Once the results of the blood test become available, The Hewitt Fertility Centre will then telephone you to arrange an appointment date and time to visit the centre and store your sperm. The appointment made will be before further treatment is due to begin (IVF,ICSI or IUI treatment).

On your sperm freeze appointment date, you will first have a consultation with a Reproductive Scientist to discuss the implications of storing your sperm and complete the relevant consent forms. You will be asked questions with regards to the storage and use of stored samples. At this appointment, you will have the opportunity to ask any questions you might have.

Next, you will be asked to produce a semen sample through masturbation. The centre has private, specially designed, sound-proof production rooms available in which you produce your sample. In some circumstances, it may be possible to produce your sample at home, provided it is delivered to the centre within one hour.

What happens to my sperm once I’ve produced a sample?

Once you have produced your sample, it will undergo a semen analysis test to quantify the quality of the sample. Your sample will then have cryoprotectant added (a liquid media that prevents damage to sperm cells during freezing) before being transferred into a number of ‘sperm straws’. The straws are gradually cooled to -196°C. Once cooled, your sample will be placed into special containers called dewars, where they will be kept in liquid nitrogen until you potentially require them for fertility treatment.

Have I produced enough sperm and what is its quality like?

The Hewitt Fertility Centre will ensure that enough of your sperm will be frozen for future fertility treatment/s. This may involve attending the centre up to two further times. We will know whether further appointments will be needed after you have produced your first sample and will arrange this with you if further appointments are required. If your sample is unsuitable for storage, you can discuss your options and next steps with your clinician. You are also welcome to use our counselling service if you wish to do so.

What are the legal implications for storing sperm?

All fertility centres are under the regulation of the Human Fertilisation and Embryology Authority (HFEA). Prior to freezing and storing sperm, it is a legal requirement that you give written consent concerning;

• Storage of your sperm and the length to which it is stored for
• The circumstances to which your sperm can be used in the future (you may have a partner with whom you wish to have a family named on your form)
• Your decision over any embryos created using your sperm
• What happens to your frozen sperm in the event of your death or incapacitation

What will happen if your sperm is not used

You are free to withdraw or vary the terms of your consent at any time. You should be aware that in the event of your death, you can have your name registered as the parent of any child or children born as a result of using your sperm, provided you have consented to this in writing. If your circumstances change, for instance you move address, change telephone number, or separate from your partner at the time of storage, it is vitally important that you make the Hewitt Fertility Centre aware of these changes immediately.

How long can sperm be stored?

 In normal cases, sperm may be legally stored for up to ten years. This storage period can be extended up to 55 years if premature infertility is diagnosed or suspected to occur. It is unlawful to store sperm beyond the period to which you consent, and the Hewitt Fertility Centre has a legal obligation to dispose of your sample once consent has expired.

Do I have to pay for freezing & storing my sperm?

This is dependent upon which NHS clinical commissioning group you fall under and what specific criteria they have set for funding sperm storage. This will be assessed before you freeze sperm.

If you qualify for NHS funding, sperm storage is typically funded by the NHS for 10 years.

When funding for storage ends, you will be contacted by the Hewitt Fertility Centre to ask whether you wish to continue storage up until the length that you have legally consented for. Continued storage after this period, will incur an annual fee.

If you do not qualify for NHS funding, sperm freezing and storage incurs a fee.

How successful is the use of frozen sperm?

 We would expect around 50 to 75% of your frozen sperm sample to survive the thawing procedure. Treatment using frozen sperm has a similar success rate to treatment using fresh sperm. Please note, success rates are partly dependant on sperm quality.

Safety & Quality

We promise to look after your sperm as carefully as possible but we cannot be held responsible for its safety or the risk of the loss of sperm due to equipment failure. In addition we cannot guarantee your sperm will survive the freeze-thaw process or that a successful pregnancy will result from its use.

The Lewis-Jones Andrology Department at the Hewitt Fertility Centre has provided a dedicated Andrology service for over 30 years. We are attached to the Hewitt Fertility Centre HFEA licenced centre 0007) and can provide all fertility treatments potentially required in the future. We also have a centre at Knutsford (Centre number 0344) where the same care can be provided if more convenient and appropriate.

Contact with the unit

 Please feel free to contact the laboratory on 0151 702 4214 or email lwft.andrologylab@nhs.net  if you require any further information about fertility preservation.

You must keep us informed of any change in your circumstances e.g. change of address. This is because we will contact you every three years to see if you still want your sperm to be stored. If we are unable to contact you, your samples will be destroyed when they reach the end of their statutory storage period. If you have any questions on sperm storage, please contact the unit and ask to speak to a member of the Andrology team.

The leaflet is detailed below, or you can download 'Freezing and Storage of Sperm Prior to Fertility Treatment' leaflet in PDF. 

Why is my sperm sample being frozen?

 The Hewitt Fertility Centre will want to make sure they have sperm to use when fertility treatment starts with your partner. Frozen sperm samples can be thawed when required and used in procedures such as artificial insemination (IUI), in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). Freezing your semen sample before fertility treatment will help maximise the chance of this being the case.

• Sperm freezing, also known as sperm cryopreservation, is typically offered for the following reasons;
• Some forms of chemotherapy, radiotherapy, surgery, and hormone therapy can lead to infertility which may be temporary or permanent. Fertility preservation is particularly important for patients undergoing cancer treatment or gender reassignment. Before any of these procedures are carried out, it is possible to store sperm using a freezing process known as cryopreservation.
• Sperm samples can also be collected and frozen in the case of a medical condition known as retrograde ejaculation, where the sperm is passed into the bladder instead of passing out through the urethra.
• If you have difficulty with or concerns about producing a sperm sample on the day of treatment.
• If the quality of your sperm sample is such that we have concerns that there may not be an adequate number of sperm to perform your ICSI treatment on the day of egg collection.
• Social reasons. For instance, not being available when your semen sample will be required during fertility treatment.

Please ask a member of staff for further information if you wish to consider freezing a sample prior to infertility treatment.

I’ve been asked to freeze my sperm, what happens next?

If your doctor has recommended sperm freezing, you will first have a blood test where we screen for HIV, Hepatitis B & C. This is for sperm storage purposes as there is a theoretical risk of viral cross-contamination between samples.

Once the results of the blood test become available, The Hewitt Fertility Centre will then telephone you to arrange an appointment date and time to visit the centre and store your sperm. The appointment made will be before further treatment is due to begin (IVF,ICSI or IUI treatment).

On your sperm freeze appointment date, you will first have a consultation with a Reproductive Scientist to discuss the implications of storing your sperm and complete the relevant consent forms. You will be asked questions with regards to the storage and use of stored samples. At this appointment, you will have the opportunity to ask any questions you might have.

Next, you will be asked to produce a semen sample through masturbation. The centre has private, specially designed, sound-proof production rooms available in which you produce your sample. In some circumstances, it may be possible to produce your sample at home, provided it is delivered to the centre within one hour.

What happens to my sperm once I’ve produced a sample?

Once you have produced your sample, it will undergo a semen analysis test to quantify the quality of the sample. Your sample will then have cryoprotectant added (a liquid media that prevents damage to sperm cells during freezing) before being transferred into a number of ‘sperm straws’. The straws are gradually cooled to -196°C. Once cooled, your sample will be placed into special containers called dewars, where they will be kept in liquid nitrogen until you potentially require them for fertility treatment.

Have I produced enough sperm and what is its quality like?

The Hewitt Fertility Centre will ensure that enough of your sperm will be frozen for future fertility treatment/s. This may involve attending the centre up to two further times. We will know whether further appointments will be needed after you have produced your first sample and will arrange this with you if further appointments are required. If your sample is unsuitable for storage, you can discuss your options and next steps with your clinician. You are also welcome to use our counselling service if you wish to do so.

What are the legal implications for storing sperm?

All fertility centres are under the regulation of the Human Fertilisation and Embryology Authority (HFEA). Prior to freezing and storing sperm, it is a legal requirement that you give written consent concerning;

• Storage of your sperm and the length to which it is stored for
• The circumstances to which your sperm can be used in the future (you may have a partner with whom you wish to have a family named on your form)
• Your decision over any embryos created using your sperm
• What happens to your frozen sperm in the event of your death or incapacitation

What will happen if your sperm is not used

You are free to withdraw or vary the terms of your consent at any time. You should be aware that in the event of your death, you can have your name registered as the parent of any child or children born as a result of using your sperm, provided you have consented to this in writing. If your circumstances change, for instance you move address, change telephone number, or separate from your partner at the time of storage, it is vitally important that you make the Hewitt Fertility Centre aware of these changes immediately.

How long can sperm be stored?

 In normal cases, sperm may be legally stored for up to ten years. This storage period can be extended up to 55 years if premature infertility is diagnosed or suspected to occur. It is unlawful to store sperm beyond the period to which you consent, and the Hewitt Fertility Centre has a legal obligation to dispose of your sample once consent has expired.

Do I have to pay for freezing & storing my sperm?

This is dependent upon which NHS clinical commissioning group you fall under and what specific criteria they have set for funding sperm storage. This will be assessed before you freeze sperm.

If you qualify for NHS funding, sperm storage is typically funded by the NHS for 10 years.

When funding for storage ends, you will be contacted by the Hewitt Fertility Centre to ask whether you wish to continue storage up until the length that you have legally consented for. Continued storage after this period, will incur an annual fee.

If you do not qualify for NHS funding, sperm freezing and storage incurs a fee.

How successful is the use of frozen sperm?

We would expect around 50 to 75% of your frozen sperm sample to survive the thawing procedure. Treatment using frozen sperm has a similar success rate to treatment using fresh sperm. Please note, success rates are partly dependant on sperm quality.

Safety & Quality

We promise to look after your sperm as carefully as possible but we cannot be held responsible for its safety or the risk of the loss of sperm due to equipment failure. In addition we cannot guarantee your sperm will survive the freeze-thaw process or that a successful pregnancy will result from its use.

The Lewis-Jones Andrology Department at the Hewitt Fertility Centre has provided a dedicated Andrology service for over 30 years. We are attached to the Hewitt Fertility Centre HFEA licenced centre 0007) and can provide all fertility treatments potentially required in the future. We also have a centre at Knutsford (Centre number 0344) where the same care can be provided if more convenient and appropriate.

Contact with the unit

Please feel free to contact the laboratory on 0151 702 4214 or email lwft.andrologylab@nhs.net  if you require any further information about fertility preservation.

You must keep us informed of any change in your circumstances e.g. change of address. This is because we will contact you every three years to see if you still want your sperm to be stored. If we are unable to contact you, your samples will be destroyed when they reach the end of their statutory storage period. If you have any questions on sperm storage, please contact the unit and ask to speak to a member of the Andrology team.

The leaflet is detailed below, or you can download 'Post-vasectomy Semen Analysis' leaflet in PDF. 

Why do I need a post-vasectomy semen analysis?

Approximately 12 weeks after your operation you are required to produce a semen sample to confirm whether your vasectomy has been successful. During the analysis we will not only check for the presence of sperm but also whether any sperm seen are motile and have fertilisation potential.

Some sperm can remain in the vas deferens in the months following your procedure. It is important that you have ejaculated (via masturbation or with contraception) over 20 times before your post-vasectomy semen analysis to help clear out any sperm that have remained.

How do I get an appointment?

You will need to be referred to us by a clinician. Once we have received your referral we will send you out a pack to the address provided to us. This pack will contain instructions, a production form, sample pot and appointment information. These instructions must be read in advance of attempting to produce your sample.

If you cannot make the appointment we have sent you please contact the laboratory on 0151 702 4214 in advance to reschedule. We are unable to accept any samples without an appointment. Appointments for post-vasectomy semen analysis are available Monday to Friday.

How can I produce the sample?

Samples should be collected by masturbation. Do not produce your sample using lubrication, condoms or through the withdrawal method.

If you are unable to masturbate, special non-toxic condoms designed specifically for the collection of semen samples are available for use at home. Please ask in advance of your appointment if this is something you require.

How do I collect the sample? 

• In order to obtain an optimum sample you are required to abstain from any sexual activity (masturbation or intercourse) for a minimum of 2-3 days, but no more than 7 days, before your appointment date.
• Produce your sample by masturbation into the non-toxic sterile pot provided in your pack. Your pot must be labelled with your name, DOB and hospital identification number.
• Please do not attempt to produce your sample into any other type of specimen pot.
• Please ensure you attempt to collect all of the semen produced.
• Once the sample has been collected please ensure the lid is screwed on tightly and place the pot inside the sealable bag provided.
• Ensure you bring the fully completed request form with you to the hospital. We cannot accept your sample until this has been completed correctly.

Where can I produce the sample?

You may produce your sample at home if you can deliver it to the laboratory at your allotted appointment time and within one hour of collection. Whilst travelling from home it is important you keep the sample close to the body as sperm are sensitive to extremes of temperature. If preferable, your partner may deliver your sample and completed production form.

If you cannot deliver your sample to the laboratory within one hour of ejaculation or would

rather produce your sample on site we have private, sound-proof production rooms available for use.

Where do I need to go?

The Lewis-Jones Andrology Department at the Liverpool Women’s Hospital (L8 7SS) is situated on the second floor. Please follow signs for the Hewitt Fertility Centre and our waiting room is situated next door.

How do I get my results?

Your results will be sent back to your referring clinician approximately 14 days after your post-vasectomy semen analysis. You should continue to use an alternative method of contraception until you have received confirmation of the success of your vasectomy, also known as clearance.

Repeat tests

If you have not ejaculated 20 times or it has not been 12 weeks since the operation you may be asked to repeat the test at a later date. You may also be asked to repeat the test if there are any sperm seen in your sample.

The presence of sperm doesn’t necessarily mean your vasectomy has been unsuccessful since some sperm may remain in the vas deferens for a while after the operation. If invited, it is important that you attend your repeat test as it will help to confirm whether all residual sperm have been cleared out of the vas deferens or if the procedure has in fact failed. It is important to know that clearance is only given to patients when the clinician can be sure that they could not achieve a pregnancy. Failure to attend your post-vasectomy semen analysis could result in an unplanned pregnancy.

Research and waste

The portion of your sample that is left over after post-vasectomy semen analysis is

disposed of by incineration. In some cases, it may be used by us for training or research.

Queries

Please feel free to contact the laboratory on 0151 702 4214 if you require any further

information about this test.

 Quality

The Lewis-Jones Andrology department at the Hewitt Fertility Centre has provided a dedicated Andrology service for over 10 years. We were the first Andrology laboratory to be accredited for quality and competence by the UK Accreditation Scheme (UKAS). Our laboratory is also enrolled in the UK National External Quality Assurance Scheme (UK NEQAS) which helps to ensure clinical laboratory test results are accurate, reliable and comparable wherever they are produced.

Feedback

We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff

The Lewis-Jones Andrology Department,

Hewitt Fertility Centre,

Liverpool Women’s Hospital

Crown Street,

L8 7SS

0151 702 4214

https://www.thehewittfertilitycentre.org.uk

The leaflet is detailed below, or you can download 'Post-vasectomy Semen Analysis (Leighton)'  leaflet in PDF. 

Why do I need a post-vasectomy semen analysis?

Approximately 12 weeks after your operation you are required to produce a semen sample to confirm whether your vasectomy has been successful. During the analysis we will not only check for the presence of sperm but also whether any sperm seen are motile and have fertilisation potential.

Some sperm can remain in the vas deferens in the months following your procedure. It is important that you have ejaculated (via masturbation or with contraception) over 20 times before your post-vasectomy semen analysis to help clear out any sperm that have remained.

How do I get an appointment?

You will need to be referred to us by a clinician. Once we have received your referral we will send you out a pack to the address provided to us. This pack will contain instructions, a production form, sample pot and appointment information. These instructions must be read in advance of attempting to produce your sample.

If you cannot make the appointment we have sent you please contact Ward 25 reception team on 01270 612212 in advance to reschedule. We are unable to accept any samples without an appointment. Please note we are only able to offer appointments on Thursdays. Please feel free to contact the reception team to find out the dates that these sessions are being held.

How can I produce the sample?

Samples should be collected by masturbation. Do not produce your sample using lubrication, condoms or through the withdrawal method.

If you are unable to masturbate, special non-toxic condoms designed specifically for the collection of semen samples are available for use at home. Please ask in advance of your appointment if this is something you require.

How do I collect the sample?

• In order to obtain an optimum sample you are required to abstain from any sexual activity (masturbation or intercourse) before your appointment. Please ejaculate 4 days before your appointment and then again 2 days before your appointment. Do not ejaculate again until you are producing your sample for analysis.
• Produce your sample by masturbation into the non-toxic sterile pot provided in your pack. Your pot must be labelled with your name, DOB and hospital identification number.
• Please do not attempt to produce your sample into any other type of specimen pot.
• Please ensure you attempt to collect all of the semen produced.
• Once the sample has been collected please ensure the lid is screwed on tightly and place the pot inside the sealable bag provided.
• Ensure you bring the fully completed request form with you to the hospital. We cannot accept your sample until this has been completed correctly.
• The pot must not be exposed to extremes of temperature either before or after sample production. If you are concerned about this, please speak to a member of staff.

Where can I produce the sample?

You may produce your sample at home if you can deliver it to the laboratory at your allotted appointment time preferably within 30 minutes after collection and at least no longer than 50 minutes after collection. Whilst travelling from home it is important you keep the sample close to the body under clothes during transportation (for example, in a pocket) as sperm are sensitive to extremes of temperature. If preferable, your partner may deliver your sample and completed production form.

If you cannot deliver your sample to the laboratory within 50 minutes of ejaculation or would rather produce your sample on site, we have production rooms available for use.

Where do I need to go?

The Andrology laboratory is located within Ward 25 at Mid Cheshire Hospitals NHS Foundation Trust, Leighton hospital (CW1 4QJ). From the Maternity and Women’s services entrance, proceed down the corridor and take the stairs/lift on the left hand side to the 2nd floor. Please report to reception upon arrival.

How do I get my results?

Your results will be sent back to your referring clinician approximately 14 days after your post-vasectomy semen analysis. You should continue to use an alternative method of contraception until you have received confirmation of the success of your vasectomy, also known as clearance.

Repeat tests

If you have not ejaculated 20 times or it has not been 12 weeks since the operation you may be asked to repeat the test at a later date. You may also be asked to repeat the test if there are any sperm seen in your sample.

The presence of sperm doesn’t necessarily mean your vasectomy has been unsuccessful since some sperm may remain in the vas deferens for a while after the operation. If invited, it is important that you attend your repeat test as it will help to confirm whether all residual sperm have been cleared out of the vas deferens or if the procedure has in fact failed. It is important to know that clearance is only given to patients when the clinician can be sure that they could not achieve a pregnancy. Failure to attend your post-vasectomy semen analysis could result in an unplanned pregnancy.

Queries

Please feel free to contact the Hewitt Andrology service on 0151 702 4214 if you require any further information about this test. PLEASE CONTACT THE WARD 25 RECEPTION TEAM DIRECTLY IF YOU WISH TO CHANGE YOUR DATE/TIME OF APPOINTMENT.

Quality

The Lewis-Jones Andrology department at the Hewitt Fertility Centre has provided a dedicated Andrology service for over 10 years. We were the first Andrology laboratory to be accredited for quality and competence by the UK Accreditation Scheme (UKAS). Our laboratory is also enrolled in the UK National External Quality Assurance Scheme (UK NEQAS) which helps to ensure clinical laboratory test results are accurate, reliable and comparable wherever they are produced.

Feedback

We appreciate and encourage feedback. If you need advice or are concerned about any aspect of care or treatment please speak to a member of staff

The Lewis-Jones Andrology Department,

Hewitt Fertility Centre,

Liverpool Women’s Hospital

Crown Street,

L8 7SS

0151 702 4214

https://www.thehewittfertilitycentre.org.uk