Reproductive Endocrinology, Infertility
and Surgery Clinic

What conditions are covered?

Within reproductive endocrinology, infertility and surgery (REIS), the following conditions are often included:

Types of tests offered

Rather than pre-testing before arrival, as most women or couples have had some degree of investigation and treatment before attending, a consultation with Mr Drakeley will help identify any outstanding tests required. Different treatment options can then be discussed.

• Infertility affects 1:7 couples. Standard work up includes a male semen analysis, female tests of normal pelvic anatomy, Fallopian tube patency, ovarian reserve and confirmation of ovulation. From this initial work up, sometimes additional investigation is needed if a problem is detected.
• Pelvic pain is a common reason for referral and can be caused by a number of conditions. Pelvic ultrasound can be useful in some cases, but for others a diagnostic laparoscopy provides more information.
• Period problems affect most women at some time of their lives. Full blood count, thyroid, pelvic ultrasound and endometrial biopsy are usually considered first line investigations.
• Polycystic ovaries are an extreme variation of normal resulting in a hormonal imbalance, which can lead to irregular periods, infertility or hirsutism (hair growth).
• Fibroids are muscular lumps of the uterus which can cause heavy periods, infertility, pressure symptoms or pelvic pain. Diagnosis is usually via examination, ultrasound or via hysteroscopy and/or laparoscopy.
• The menopause can really affect a woman’s quality of life. Diagnosis is usually via history and blood tests.
• Pre-menstrual syndrome encompasses a number of symptoms which worsen just before a period and usually subside with the onset of menstruation. Diaries can be helpful with pin pointing the severest symptoms.
• Some women find it easy to get pregnant but tend to repeatedly miscarry. Most women will succeed in pregnancy eventually, but there are tests which can be performed for the commoner causes of recurrent pregnancy loss.

Types of treatments offered

• Treatment for infertility will depend on the cause found but can include ovulation induction (clomiphene tablets), artificial insemination or assisted conception via in vitro fertilisation (IVF) or intra-cytoplasmic sperm injection (ICSI). Sometimes men require a testicular biopsy (TESE) to bypass obstructive causes such as previous vasectomy. For some couples egg or sperm donation is required. Cycle monitoring can be arranged.
• Mild to moderate endometriosis, ovarian cysts or blocked Fallopian tubes are often dealt with via laparoscopic (keyhole) surgery. If very extensive, sometimes a bowel Surgeon and Urologist are required to be in attendance.
• For period related issues, sometimes tablets taken at the correct times of the month are all that is required. For some, a Mirena coil (progesterone releasing) is the treatment of choice, whereas for other women endometrial ablation or hysteroscopic resection works well. Finally hysterectomy more definitively stops periods.
• For PCOS, treatments will depend on the individual on where they are in life.
• Fibroids can be shrunk with injections, removed hysteroscopically (if in the uterine cavity), myomectomy or via hysterectomy. They can also be shrunk via uterine artery embolisation. Management of symptomatic fibroids will depend on the individual.
• The treatment of the menopause had been via the use of HRT (hormone replacement therapy) until recent data suggested increased links to breast cancer and other diseases if taken long term. Individualised specialist advice will be given to the woman on this subject.
• PMT can be supported with hormones, antidepressants or psychological support.
• Recurrent miscarriage management will depend of any cause found and may involve anti-coagulants. Occasionally uterine surgery may be warranted. For most, supportive care with regular ultrasound reassurance scans will be of benefit.