Alma Fertility - The Female Founded Clinic in South West London.

Written by Dr Shabana Bora, Consultant gynaecologist and fertility specialist

We’ve sat down with Dr Shabana at Alma Fertility, and answered your questions 

1. How do I choose a fertility clinic?

This is a commonly asked question, but the answer is not straightforward, as fertility clinics now have different approaches to the way care is delivered.

Larger, long-standing, reputable clinics can often come highly recommended, as they have built trusted relationships with patients over many years. However, this can sometimes mean that patients are looked after by multiple different people, as one clinician may not have the capacity to care for large numbers of patients day to day. They often do, however, have the capacity to start treatment at short notice and offer more flexible working hours.

Success rates can understandably be an important factor when choosing a clinic. However, these figures can sometimes be difficult to compare, as some clinics may decline to treat patients based on factors such as age, ovarian reserve or previous treatment history. This can mean that their published results appear better because they are treating patients who already have a more favourable prognosis.

On the flip side, there are now many ‘independent’ smaller or satellite clinics that offer more one-to-one care. Here, the clinicians often get to know the patient from the outset and may manage their care from start to finish. This can feel more personal, less transactional, and some patients find this a more favourable experience.

The disadvantages of seeking more bespoke, individualised consultant care are that there may be a waiting list to start treatment, less flexibility with appointment times and, on occasion, higher costs.

My advice is not to rely too heavily on reviews or simply on the reputation of a clinic. If you feel that the first clinic you visit is not the right one for you, consider getting a second opinion.

Secondly, consider distance. Your travel time to the clinic is an important factor, as you may spend a significant amount of time travelling back and forth for appointments, scans and treatment.

Often, patients get a ‘feel’ for what feels right for them. There is no one-size-fits-all model of fertility care.

2. When should I start considering whether I need extra help to get pregnant?

This is partly age-related, but some women feel empowered by having a better understanding of their chances of conceiving.

As a fertility specialist, I have seen patients at all ends of the spectrum. Some come before they have even considered pregnancy, simply to understand more about their reproductive health, while others try for years before they come to see me.

Current NICE guidance recommends seeking assessment if you have not conceived after 12 months of regular unprotected sex, although it may be appropriate to seek advice sooner depending on your age, medical history and individual circumstances.

If you are concerned about your fertility, you do not necessarily have to wait 12 months before seeking advice. Sometimes simply having a conversation with a fertility specialist can provide reassurance or help you understand your options.

These are not arbitrary cut-offs, but a guide. Everyone is different, so there is no single right or wrong time to seek help. Get checked or seek advice when it feels right for you

3. I'm over 35. Will my IVF success rates be low?

Not necessarily.

Fertility does decline with age, largely because both the number and quality of our eggs decrease over time. As we get older, there is also a higher chance of chromosomal abnormalities occurring in our eggs.

If you need IVF, your chances of success will depend on a number of factors, including your age, ovarian reserve, the number of eggs collected and how the embryos develop.

The chances of success are generally lower as we get older, but this does not mean that they are necessarily ‘low’. Your fertility specialist should be able to give you a more individualised idea of your chances based on your own circumstances.

4. I've had several miscarriages. Can a fertility clinic help?

Yes, definitely.

There is a common misconception that if you are getting pregnant but miscarrying, you do not need fertility treatment because ‘infertility’ is not the issue. However, this is not necessarily the case.

A fertility specialist can help investigate possible reasons for recurrent miscarriage and discuss whether any investigations or treatments may be appropriate for you.

Sometimes a cause can be identified, but unfortunately, in many cases no clear reason is found. This does not mean that you cannot have a successful future pregnancy. With the right advice, investigation and supportive management, many women go on to have a healthy pregnancy.

5. I have PCOS or endometriosis. Will I need IVF?

Not necessarily.

Having PCOS or endometriosis does not automatically mean that you will need IVF. Many women with these conditions conceive naturally, although the severity of the condition can affect fertility.

With PCOS, fertility problems are often related to irregular or absent ovulation, while endometriosis can affect fertility in a number of different ways.

This is why early assessment and individualised advice can be helpful, particularly if you have been trying to conceive for some time.

For women who do need assisted conception, including IVF, there are a number of treatment options available. Your reproductive medicine specialist can help guide you towards the approach that is most appropriate for you.

6. What's the one piece of advice you'd give someone trying to conceive?

The vast majority of women will eventually become pregnant, and for those who need a little extra help, there is a community of trusted physicians, nutritionists, coaches and allied health professionals who are there to support you every step of the way.

I would always encourage women who are struggling with fertility to talk to someone early - to alleviate stress, share their story and get support.

Look after yourself and be the very best version of you. Eat well, sleep well, be nourished and do everything you can to control what you can control, because getting pregnant is not always something we can control.

And, although this isn’t advice per se, have hope and believe that it can work. With that, and a bit of good luck, you will get there.