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  • General

Every Call Handled: an exciting milestone for The CRP Clinic

The CRP Clinic is excited to announce the introduction of our bespoke AI receptionist, who operates twenty four hours a day, to ensure the most efficient care for our patients. This marks a significant step forward in improving accessibility: it ensures prospective patients can book an appointment whenever is most convenient for them. Our new AI receptionist improves customer convenience and clinic responsiveness.

How CRP Patients Will Benefit

With our AI receptionist:

  • Patients will have 24/7 access to the clinic, with the ability to book initial consultations online
  • Existing CRP patients can book routine blood tests and Intralipid infusions through the AI receptionist, in line with their current treatment plan (T&Cs apply).
  • All calls are logged and will be responded to by the team during the clinic’s opening hours.
  • For any medication queries or appointment requests outside of these services, patients can leave a message with the AI receptionist, and a member of the team will follow up as soon as possible.

The service is convenient: it saves our patients valuable time, by reducing the need for repeated emails and calls.

How ECH Works

The service is powered by Every Call Handled, London-based AI system specialists. Their pioneering conversational assistant answers all queries instantly, and guarantees a “warm welcome and responsive conversation.” (https://everycallhandled.com/#how) The new, bespoke receptionist will be available to answer calls, and book new patient appointments directly into the clinic’s diary, Semble Patient Management System (also known as PMS). Patient details obtained through PMS are completely secure. The receptionist has been built by ECH to be specifically catered for the CRP Clinic. We understand that the AI landscape is new, and that there may be some trepidation with this development. We can assure that the assistant operates within perimeters that our clinical team have already defined – it will never give medical advice, and no appointment will be finalised until a member of our team has spoken to the patient directly.

What This Change Means…

This operational change means that hours of repetitive work have been eradicated. This means that our team save time, and are able to prioritise the work that only they can do. For prospective patients, it ensures that the phone is always answered, day and night.

The Benefits

We have already seen a remarkable improvement in patient satisfaction. The CRP Clinic’s new, bespoke AI receptionist’s involvement does not compromise safety or professionalism, it merely streamlines the process of booking an appointment with us. 

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Couple discussing fertility care at CRP Clinic
  • Health

Can Male Fertility Cause Miscarriage?

When a couple experiences miscarriage, the focus of investigation has traditionally fallen on the woman. Hormonal imbalances, immune factors, uterine abnormalities — these are well-recognised causes, and rightly investigated. But for too long, the male contribution to pregnancy loss has been overlooked.

The science is now clear: male fertility can play a significant role in miscarriage. And at the CRP Clinic in Epsom, this is something we take seriously.

The Missing Piece: Sperm DNA Fragmentation

Sperm carry half of the genetic material needed to create a healthy embryo. If that genetic material is damaged, it can compromise the developing pregnancy, even when fertilisation has occurred successfully.

This damage is known as sperm DNA fragmentation (SDF): breaks or lesions within the DNA strand of individual sperm cells. While a standard semen analysis can assess sperm count, movement, and shape, it tells us nothing about the integrity of the DNA inside those sperm.

A man may have a perfectly normal semen analysis and still have high levels of DNA fragmentation.

What Does the Research Tell Us?

Professor Shehata and colleagues at CRP Clinic contributed directly to answering this question. A peer-reviewed study published in ‘Reproductive BioMedicine Online’ (2021) examined sperm DNA fragmentation (measured using the alkaline Comet assay) in 217 men whose partners had experienced miscarriage, compared to 76 fertile donors.

The study found that sperm DNA fragmentation measures were robust biomarkers for both sporadic and recurrent miscarriage, whether conception occurred naturally, or through assisted reproductive techniques such as IVF or IUI. The findings suggest that sperm DNA testing could provide pioneering diagnosis and guide future fertility pathways for couples experiencing pregnancy loss.

(Haddock L, Gordon S, Lewis SEM, Larsen P, Shehata A, Shehata H. Sperm DNA fragmentation is a novel biomarker for early pregnancy loss. Reprod Biomed Online. 2021 Jan;42(1):175–184. doi: 10.1016/j.rbmo.2020.09.016)

This research matters because it places sperm DNA fragmentation not as a peripheral concern, but as a clinically meaningful factor in pregnancy loss, one that deserves to be tested alongside the many investigations women already undergo.

What Causes High Sperm DNA Fragmentation?

A number of lifestyle and medical factors can increase the level of DNA damage within sperm:

  • Excess weight or obesity 
  • Smoking
  • Infections (including sexually transmitted infections)
  • Elevated scrotal temperature (e.g. from hot baths, laptops, or tight clothing)
  • Varicocele (enlarged veins in the scrotum)
  • Exposure to heavy metals or environmental toxins
  • Chemotherapy or radiotherapy
  • Certain medications

Many of these factors are modifiable. Identifying them early means there is often something that can be done.

Comfortable patient waiting area at CRP Clinic

Testing at CRP Clinic

At CRP Clinic, we offer specialist sperm DNA integrity testing as part of our comprehensive couple assessment.

The process is straightforward. Men are advised to ejaculate two to three times in the week before the test, then abstain for 48 hours prior to providing the sample. The sample is sent to a laboratory in Copenhagen, preserved in liquid nitrogen, for detailed analysis.

If results show elevated DNA fragmentation, we arrange a consultation with our specialist urologist, Mr Stephen Gordon, for further evaluation and to explore treatment options.

Following any recommended treatment, a complimentary repeat test is offered after three to six months to assess the impact on sperm health.

What Happens If Fragmentation Is High?

Where high sperm DNA fragmentation is identified and couples are proceeding with IUI, we offer an advanced sperm selection technique called Zymot microfluidic separation. This device selects sperm with the least amount of DNA damage, which may improve the chances of a successful pregnancy in eligible couples.

For couples undergoing IVF, identifying high fragmentation can also inform decisions about fertilisation technique and embryo selection.

A Shared Journey

Miscarriage is never the fault of either partner. But understanding all the contributing factors, including male factors, gives couples the best possible chance of finding answers and moving forward with a targeted, evidence-based treatment plan.

At CRP Clinic, we investigate both partners thoroughly. Over 80% of our patients go on to have successful pregnancies following our tailored treatment programs. That outcome is possible because we look at the full picture.

Take the Next Step

If you have experienced recurrent pregnancy loss or unexplained miscarriage, we encourage you to reach out. Our team, led by Professor Hassan Shehata, will listen carefully, investigate thoroughly, and walk with you every step of the way.
Supportive consultation imagery for recurrent miscarriage and fertility care article
  • General, Health, Miscarriage

Between Science and Advocacy: Why Recurrent Miscarriage and Fertility Care Are Also Women’s Health Advocacy

Throughout my career, I have often found myself working at the intersection of two worlds. One is the world of science: laboratory tests, ultrasound scans, immune markers, treatment protocols, clinical trials and the constant search for better answers for couples experiencing recurrent miscarriage or unsuccessful assisted conception, including in-vitro fertilisation (IVF). The other is the world of advocacy: standing up for women’s rights, challenging inequalities, improving maternity safety, and speaking out on issues such as female genital mutilation (FGM), language barriers and access to dignified care.

At first glance, these may seem like very different areas of work. But to me, they are deeply connected.

Recurrent miscarriage and unsuccessful IVF are not only medical problems. They are also emotional, psychological and often silent experiences.

Many women and couples arrive at the clinic having been told to “just try again”, or that nothing can be done until they have experienced several losses or failed attempts. Others feel that their grief has been minimised because the pregnancy was early, or because fertility treatment is sometimes seen only through the lens of success rates and cycles. Some have spent years searching for answers, moving repeatedly between hope and disappointment.

This is where science matters. At CRP Clinic, our work is built around careful assessment, evidence-informed investigation and personalised treatment. We look at possible contributing factors, including anatomical, hormonal, genetic, immune and male-related issues. We also recognise that medicine is constantly evolving. Being at the cutting edge does not mean offering every new test or treatment uncritically; it means remaining curious, rigorous and honest about what we know, what we are still learning, and how best to support each individual patient.

But science alone is not enough.

Professor Hassan Shehata at CRP Clinic in Epsom

Women’s health has too often been shaped by silence, stigma and inequality. Whether we are talking about miscarriage, stillbirth, infertility, menstrual health, menopause, gender-based violence or FGM, the common thread is that women’s experiences have not always been heard, believed or prioritised. Advocacy is therefore not separate from clinical care. It is part of it.

My work with the Royal College of Obstetricians and Gynaecologists (RCOG), International Federation of Gynaecology and Obstetrics (FIGO) including global women’s health, maternity safety, language barriers and the prevention of the medicalisation of FGM, artificial intelligence (AI) has reinforced one important principle: every woman deserves to be listened to, respected and cared for as a whole person. That same principle guides my work in recurrent miscarriage and assisted conception.

A woman who has experienced repeated pregnancy loss or unsuccessful IVF attempts does not need only a list of investigations. She needs time, clarity, compassion and a plan. She needs her story to be taken seriously. She needs a clinician who understands both the science and the human cost of uncertainty.

For me, balancing advocacy and science is not a challenge; it is a privilege.

Science pushes us to ask better questions and improve outcomes. Advocacy reminds us why those outcomes matter.

At the CRP Clinic in Epsom, our aim is to bring these two worlds together: advanced, personalised care delivered with humanity, honesty and respect. Because behind every test result is a person, behind every pregnancy loss is a story, behind every unsuccessful fertility treatment is courage, and behind every treatment plan is hope.
  • General, Success Stories

Finding Hope Again with CRP

After experiencing three heartbreaking losses (two miscarriages and a TFMR due to anencephaly) we felt completely lost and unsure if we would ever become parents.

Finding the CRP Clinic and Professor Shehata in March 2022 changed everything for us.

After thorough testing, Professor Shehata discovered that my natural killer cells were elevated, and we began treatment with the CRP team.

For the first time in a long time, we felt hopeful again.

Throughout my pregnancy, we were mainly looked after by Miss Edge for our scans, and she was absolutely fantastic.

So kind, reassuring, and supportive during what was naturally an anxious time for us.

Thanks to their care we welcomed our beautiful rainbow daughter Luna in May 2023.

She is everything to us and has brought more joy into our lives than we ever thought possible.

When we decided to try for a second baby, returning to CRP felt like the most natural decision.

We saw Professor Shehata again in February 2025 and began treatment once more.

We were incredibly lucky to fall pregnant again and welcomed our baby boy, Liam, in December 2025.

We are endlessly grateful to Professor Shehata, Miss Edge, and the entire CRP team.

Everyone we encountered was compassionate, understanding, and truly dedicated to helping us.

Despite going through medical treatment, we always felt cared for and supported.

Quite simply, we would not have our two beautiful children without them.

We will be forever grateful to the CRP Clinic for helping make our family possible.

Camila & Liam
  • Success Stories

Our Rainbow Baby Story: Thank You, CRP

Hello CRP family,

I’ve been meaning to send this email for months now, but honestly, I kept putting it off because I just couldn’t find the right words to sum up how thankful we are.

How do you even begin to thank the people who helped make your dream come true? 😃

So… here goes!

Because of your help, your diagnosis, your support, and your treatment, we are now the incredibly proud parents of our beautiful rainbow baby — Scarlett Rose.

She’s the sweetest little character, full of personality already, and she’s made my dream of being a mummy even better than I ever imagined.

Before coming to CRP, I thought fertility appointments would feel daunting and clinical.

How wrong I was!

From the very first consultation to our final pregnancy scan with you at 20 weeks, you made every step of the journey feel clear, calm, and full of hope.

You explained our “unexplained” infertility, treated it, and gave us the greatest gift — our perfect little bean.

Every time I walked through your doors, I felt like I was walking into a warm, welcoming home.

You have this lovely family atmosphere that somehow melts away the nerves.

Our special thanks:

Dr. Edge — you’re pure sunshine in a lab coat.

You explained everything so positively, and those pregnancy scans… you spent ages getting the clearest photos, like you genuinely wanted us to have the best keepsakes possible.

It meant so much.

Professor Shehata — our superhero!

I first heard you on a podcast and instantly knew I needed to come to your clinic.

You spoke with such passion and common sense about finding and fixing the root cause of fertility struggles.

And after just one round of testing, you looked me in the eye and said, “We can treat this!”

And you did. 😃

Thank you for your brilliance, your belief, and your wonderfully quirky fashion sense — we are so grateful!

Geri — your free spirit and sense of humour kept me laughing even when I was feeling nervous.

Marianna — so sweet, caring, and somehow remembered my old test results without even checking the notes (super impressive!) which saved delays, extra cost and made me feel truly cared for.

The doctor who did the Nuchal scan (I can’t remember his name now, sorry!) you made us smile just by showing a glimpse of the real person behind the white coat. 🤘

Loved our chats!

Your team are really something special.

Every single one of the staff we met were brilliant.

And that gorgeous photo frame you gave us when we “graduated” — it now has pride of place in Scarlett’s nursery.

The rest of my pregnancy went smoothly, and even the C-section was a lovely experience.

Scarlett did have hip dysplasia at birth, but the little harness she wore for 2 months didn’t bother her a bit.

She’s now hip-healthy and zooming around soldier crawling at 6 months old.

She even sleeps with her arms over her eyes — exactly like she did in every scan picture you did for us! 🙈

We love her more than words can say, and we owe that to all of you.

Thank you from the bottom of our hearts for helping us bring the most magical little girl into our lives.

You should all be incredibly proud of the work you do — you don’t just help create families, you really change lives.

Sending big hugs from all three of us,

Sarah, Simon & Scarlett Rose 🌹 xx
  • General, Health

PRP in Fertility Treatment: What Patients Should Know

If you’ve started reading about PRP, it’s likely your fertility journey hasn’t been simple. Maybe your IVF cycles haven’t worked as hoped. Maybe embryo transfers were cancelled because your lining didn’t develop well. Maybe you’ve heard this mentioned as a “next step” and you’re trying to understand whether it’s right for you.

We’d like to explain PRP clearly and honestly — what it is, where it may help, and where expectations need to be realistic.

What is PRP?

PRP stands for Platelet-Rich Plasma.

It’s prepared from a small sample of your own blood. That blood is processed to concentrate platelets — cells that naturally release substances involved in:

  • Tissue repair
  • Formation of new blood vessels
  • Cellular healing and regeneration

These substances, known as growth factors, act like signals that help tissues respond and recover. PRP has been used in other areas of medicine for years, including orthopaedics and wound care. In fertility treatment, its role is still being studied.

Why is PRP Used in Fertility Care?

For an embryo to implant successfully, the uterine lining must:

  • Reach adequate thickness
  • Have good blood supply
  • Be biologically receptive to implantation

PRP is being explored because its growth factors may help support tissue response and blood vessel development in the endometrium.

Research is ongoing. Some patients appear to benefit, while others do not. It is not a universal solution.

PRP For a Thin Uterine Lining

One of the main situations where PRP is considered is when the lining remains thin despite standard treatments such as oestrogen therapy.

Why Lining Thickness Matters

A poorly developing lining can be associated with lower implantation rates. However, thickness alone does not determine success – lining quality and embryo health are equally important.

What Studies Show

Some clinical studies have reported that in selected patients:

  • PRP placed into the uterus may increase lining thickness
  • Some patients subsequently achieve pregnancy

However:

  • Many studies are small
  • Not all are randomised or high-quality trials
  • Results are not consistent for everyone

For this reason, PRP for thin lining is seen as a developing option, not routine treatment.

PRP For Repeated Implantation Failure

When good-quality embryos do not implant, it can be extremely difficult. Repeated implantation failure can involve multiple factors:

  • Embryo chromosomal abnormalities
  • Uterine conditions
  • Hormonal balance
  • Immune factors
  • Sometimes, chance

PRP has been studied as a way to improve the uterine environment in these cases. Some research suggests it may support blood flow and influence implantation-related signals. Still, it does not address embryo genetic issues, which remain a major cause of failed implantation.

PRP may be considered in selected cases, particularly when there is concern about lining development or uterine receptivity.

PRP and Ovarian Function

PRP has also been discussed for low ovarian reserve or poor ovarian response. This involves injecting PRP into the ovaries.

At present:

  • Research is at an early stage
  • Evidence is limited
  • This approach is considered experimental in most fertility settings

Patients should approach this option with careful counseling.

Is PRP Safe?

Because PRP uses your own blood, allergic reactions are unlikely, as long as it is performed in an appropriate medical setting.

Long-term fertility data are still evolving.

What PRP Can and Cannot Do

PRP is not:

  • A guarantee of pregnancy
  • A treatment for embryo chromosomal abnormalities
  • A substitute for a full fertility evaluation

It may be considered when:

  • The lining repeatedly does not develop adequately
  • Standard approaches have not been successful
  • There is a reasonable medical basis to focus on the uterine environment

PRP works, if at all, as part of a broader, individualised treatment plan.

Why Individual Assessment Matters

After repeated disappointments, it’s completely understandable to want to try everything available. However, additional treatments should always be chosen for a clear medical reason.

At CRP Clinic, we use add-on treatments only when they are appropriate for the individual, not simply because they are available.

A Final Note From Our Team

Needing more detailed investigations or advanced treatment does not mean you’ve done something wrong. Recurrent implantation difficulties and lining problems are complex medical issues, and they deserve thoughtful, specialist care.

PRP is one of several developing tools in fertility medicine. For some patients, it may play a role. The most important part of care, however, is a plan built around your specific history, based on current evidence and delivered with support throughout the process.

You do not have to make these decisions on your own.
  • General, Success Stories

Against The Odds

We will be forever grateful to Professor Shehata, Ms Edge, Mr Jan and the nursing team at the CRP clinic. We now have a beautiful, healthy, 10 month old daughter who was very much born against the odds.

I came across Professor Shehata’s details on the Tommy’s charity website. He was also referenced quite a bit on an IVF messaging board that I followed. By this point, we had been trying unsuccessfully for a baby for 5 years.

I had had 5 IVF embryo transfers, including the last 2 with donor eggs and I had experienced 2 implantation failures and 3 early miscarriages. I knew that I had low egg reserve following cancer treatment some years earlier, but I also felt that something else was at play which was causing the early miscarriages. However, I felt I was getting nowhere when I raised this with my IVF clinic.

Professor Shehata was incredibly detailed in his testing and he diagnosed me with very high Natural Killer Cells. He also advised me to have key hole surgery to remove 9 fibroids which were outside the uterine cavity.

Some months after the surgery with Mr Jan, which was a complete success, I started a drug regime to suppress my Natural Killer cells and then had a 6th embryo transfer at my IVF clinic.

Following a positive pregnancy test, I was monitored throughout pregnancy by the CRP and they also treated me in the early stages of pregnancy for a subchorionic hematoma, which might otherwise have resulted in early miscarriage.

The level of care provided is exceptional and the kindness of the staff is also amazing. I wish that the work of the CRP could have a broader reach, as I believe many more women would benefit from their treatment. I also wish we had found Professor Shehata sooner and avoided some of the heartache of repeated IVF failure and early miscarriage.

I would recommend the clinic to anyone who has experienced similar issues.
  • Success Stories

Our Journey to Teddy

In December 2022, I sadly suffered my third miscarriage. At that point, we decided it was time to get a second opinion.

We had consistently been told that the reason for our baby losses was due to my weight and that we were simply “unlucky.”

After doing some research, we found Professor Shehata at the CRP Clinic. From our very first appointment in January 2023 right through to today, the whole team have been amazing.

I was diagnosed with high NK cells and given a treatment plan. Without the CRP Clinic, our baby boy Teddy would not be here today.

Professor Shehata, Ms Edge, and Mr Jan are truly incredible at what they do. Geri and Marianna were also extremely supportive, especially during the IVF process.

Thank you all for everything you’re doing – we are so deeply grateful. Our little man is only here because of the care and treatment we received.
  • General

Don’t Tell Me To RELAX – A Fertility Podcast

Professor Hassan Shehata joins Hannah Pearn on her podcast to discuss the complexities of reproductive immunology, particularly focusing on recurrent miscarriages and IVF failures.
They discuss:
  • How Reproductive Immunology focuses on the immune system’s role in pregnancy.
  • Why recurrent miscarriage is not typically caused by chromosomal abnormalities.
  • How investigation should begin after two miscarriages, or one if late.
  • How Male factors are often overlooked in miscarriage investigations.
  • How testing protocols vary between NHS and private sectors.
  • Why Natural killer cells play a significant role in recurrent miscarriage.
  • How IVF does not improve outcomes for recurrent miscarriage patients.
  • Why medications like prednisolone may have immune modulation effects.
  • How microbiome testing is an emerging area but lacks conclusive evidence.

 
  • Success Stories

The Most Precious Gift

Where do we start thanking Professor Shehata and the CRP Clinic for the most precious gift we could ever have dreamed of, our Son Charlie born 16/06/2024.

We first came to the CRP Clinic back in February 2022. With no clear reason as to why we suffered four miscarriages, we self referred to the NHS side of the Recurrent Miscarriage Clinic to try and determine the issue. Having been with them for a year and experiencing a further loss during this time, we clearly needed further help. This is where Professor Shehata and his team at the CRP Clinic came to our rescue.

Under the care of Professor Shehata and Dr Marianne Edge, having determined whilst with the NHS that the reason for the losses was due to a extreme level of NK Cells, they navigated us through different courses of medication in order to find the correct prescription for me.

Unfortunately we did suffer another loss during this process however they never gave up on us and persisted to get us back on track and make our dreams come true.

No longer than 2 months after the loss we were pregnant again. It was a surprise that I was able to fall so quickly but once again we was navigated through this frightful journey again.

The care and support we got from the clinic helped us push through each and every scan (fortnightly) before finally reaching the stage of 20 weeks when we were then released to be under the care of the NHS.

There are so many people that we need to thank. Dr Marianne Edge, who saw me for most of my scans, calmed me down each and every time, Geri, who held my hand and cried with me wanting this as much as us, Georgia, who would be the first face I would see at reception and would take the time to see how I was and if theres anything they can do and also Michaela, who answered all my emails with questions I had about worries, settled my mind on many occasions. Finally, Proffessor Shehata. We wouldn’t have a family without your knowledge and wisdom on the matter. I know I was his nemesis but with his persistence and patience we got our miracle little boy.

We will be back for number 2 in the near future!
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Clinic Fees

  • Initial consultation – £370 (a deductible £100 deposit is required to secure this appointment)
  • Follow up consultation – £210
  • Immune tests – tests range from £160 to £735 each
  • Wellbeing tests – tests range from £65 to £215 each
  • Hormonal tests – tests range from £90 to £260 each
  • Non-invasive Fetal DNA testing – £470
  • Initial scan – £245
  • 3D saline scan – £475
  • HyFosy – £500
  • 3D saline scan + Hyfosy – £655
  • Early pregnancy scans (includes consultation) – £305
  • 3D ultrasound scan (with AFC) – £350
  • Nuchal scan (includes blood tests) – £360
  • Anomaly scan – £360

  • Fetal Medicine scan packages are available on request.

  • Prenatal assessment (11-13 week nuchal and 20-24 fetal anomaly scans – £650
  • Growth scans package (28, 32 and 36 weeks scans) – £900
  • Main Obstetric scans package (11-13 week nuchal, 20-24 fetal anomaly and 34-36 week scans) – £900 
  • Full obstetric scans package (11-13 week nuchal, 20-24 fetal anomaly, 28, 32 and 36 weeks scans) – £1400
  • Comprehensive obstetric scans package (11-13 week nuchal, 20-24 fetal anomaly, 24, 28, 32 and 36 weeks scans) – £1700
  • Manual Vacuum Aspiration (MVA) – from £2,000
  • Hysteroscopy – from £1,365
  • Initial consultation –  £300
  • IVF Returning patient Consultation – £275
  • Pre-IVF scan and consent check for HFEA forms – £350
  • IVF Follow up Consultation – £225
  • IVF cycle –  From £3,950 (excludes initial and nurse consultations medications,  pre-IVF investigation tests)

    IVF packages are available on request
  • Initial consultation – £285
  • Nurse consultation – £200
  • IUI cycle –  From £1,200 (excludes initial and nurse consultations medications,  pre-IUI investigation tests)

    IUI packages are available on request

  • Sperm DNA Integrity – £515
  • Semen Analysis – £235

Procedures

  • Hysteroscopy (no sedation) – £1765

  • Hysteroscopy (sedation) – £1830

  • Operative Hysteroscopy + removal of polyp or adhesion – £3300

  • Operative Hysteroscopy (sedation) – £3435

Clinician Fees

  • Mr Jan Consultation + Ultrasound if required pre-Hysteroscopy – £475

Anaesthetist Fees

  • Dr Shetty – £300

  • Dr Girgis – £250

  • Dr Muddanna – £250

Additional Fees

  • Products of conception (PROC) – £465
  • Cat1 Histology – £237
  • Hyalobarrier Gel + Antibiotics – £300
  • Handling Fees – £35
  • Penthrox – £75

Insurance Information

Utrogestan

Utrogestan contains progesterone, which is a natural female sex hormone, produced in the body. It works by adjusting the hormone balance within the body. It is used in different indications related to pregnancy such as IVF and pre-term birth. Recent findings have suggested that women who are at risk of a miscarriage because of current pregnancy bleeding and a history of a previous miscarriage, could also benefit from progesterone treatment.

Given as routine to all women with history of recurrent pregnancy loss or preterm labour.

400mg, oral tablets, started around the time of ovulation until 16 weeks of pregnancy.
In some cases, Utrogestan may be used until 34 weeks.

Should be used with caution with diabetes, epilepsy, hypertension, migraine and cardiac dysfunction.

Bloating, fluid retention, breast tenderness, cramp-like pains due to gastric disturbances and skin irritation, possible menstrual cycle irregularities.

Hydroxychloroquine

Hydroxychloroquine was originally an anti-malaria drug used in the 1940s but more recently has found a place in the treatment of conditions such as Rheumatoid arthritis and Lupus. This is because it has immune properties and seems to calm down inflammation. We have used it against Natural Killer Cells with possible help in women with miscarriages and fertility conditions. There are several publications which have shown its benefit in reducing risk of miscarriages and other immune related complications in pregnancy.

This drug could be considered in complex cases or if there are contraindications to use prednisolone.

300–400mg oral tablets. Usually started 4-6 weeks prior to pregnancy. A higher (loading dose) may be required for the first two days of use. The duration of the therapy will be based on individual circumstances.

Neurological disorders (especially in epilepsy), severe gastro-intestinal disorders and G6PD deficiency. Not to be used with azithromycin antibiotics.

Gastro-intestinal disturbances, headache and skin reactions, visual changes, hair loss and pigmentation of the skin, nails and mucous membranes.

You will be required to organise a pre-treatment eye examination and every 6 months whilst taking hydroxychloroquine at your local optometrist. Three monthly wellbeing bloods will be performed.

Most of our patients have tolerated this medication well and it has a good track record in pregnancy with no apparent fetal harm. If you are taking omeprazole, please ensure that you take the two medications at different times as it may inhibit absorption of the hydroxychloroquine.

Intralipid Infusion

Intralipid infusion therapy is a sterile fat emulsion containing soya oil, chicken egg yolk, glycerine and water. The infusion is in liquid form and administered through the veins with an intravenous(IV) cannula*.

The procedure is carried out in the Epsom clinic only as part of your treatment programme. Although not subjected to controlled trials, there are observed benefits in women with miscarriages and fertility conditions.

*Peripheral intravenous (IV) cannulation is an invasive procedure, and risks include phlebitis which may lead to pain or swelling at the infusion site.

Used as part of the treatment programme for high or complex NK cells.

If intralipids are to be included as part of your plan, these will need to be administered
within the CRP Clinic at Epsom where we follow strict clinical guidelines during preparation, administration and delivery of your intralipid therapy to maintain the highest levels of patient safety. Poor safety standards can lead to the introduction of micro-organisms, which may cause infection and other associated risks, including sepsis.

100ml bag of 20% intralipid given as an intravenous dose over 1 hour. The infusion may be required before ovulation, at positive pregnancy test and then repeated every 4 weeks until
20 weeks of pregnancy.

Allergies to Eggs or Soya. Liver disease.

Note: It is important to inform staff if you have had an illness such as a viral infection or diarrhoea and vomiting in the 48 hours prior to your infusion.

Headaches, dizziness, flushing, drowsiness, nausea, vomiting or sweating.
It is rare to have side effects in well patients.

Common side effects we have observed in our patients have included pain/swelling/redness at the infusion site and temperature fluctuations.

Serious side effects (more likely to occur in patients that require this medication on a regular basis for other health issues unlike fertility or miscarriage patients) include: signs of infection (fever, persistent sore throat), injection site reactions (pain, swelling, redness), pain/swelling/ redness of arms and legs, bluish skin, sudden weight gain, shortness of breath, back or chest pain, mental/mood changes, bone pain, muscles weakness, yellowing of skin and eyes, dark urine, bruising or bleeding, severe stomach or abdominal pain.

Omeprazole

This drug belongs to a group called ‘proton pump inhibitors’. They work by reducing the amount of acid that your stomach produces. Omeprazole is mainly used to help reduce the acidic effect of steroids in the stomach.

For patients started on steroids such as Prednisolone, omeprazole is advised to prevent ulcers from forming in the stomach or gut lining.

20mg tablet once a day before breakfast.

Omeprazole is widely used in pregnancy. It is not known to be harmful to an unborn baby.

Headache, effects on your stomach or gut such as diarrhoea, stomach pain or constipation. Nausea and or vomiting.

Fragmin

Fragmin belongs to a group of medicines called low molecular weight heparins, which helps prevent the formation of blood clots by thinning the blood. It is widely used in pregnancy for reducing the risk of blood clots in the mother and in conditions associated with baby growth restriction.

Routinely prescribed in women undergoing treatment with IVF/ICSI and in cases of thrombophilia.

Dose is determined by weight, usually ranging between 5000 and 10 000 units, taken by subcutaneous injections once daily, taken between 6-9pm. Duration of medication is decided on a case-by-case basis.

Manufacturer advises caution in severe hepatic and renal impairment. Not known to be harmful in pregnancy; caution in patients with hypersensitivity to low molecular weight heparins.

Haemorrhage, skin necrosis, low platelets, high potassium, hypersensitivity reactions (including urticaria, angioedema and anaphylaxis); osteoporosis after prolonged use
(and rarely alopecia).

Blood clotting levels ad your full blood count will be checked at 3 monthly intervals.

Prednisolone

Prednisolone belongs to a group of medicines called steroids (corticosteroids). These steroids occur naturally in the body to maintain health and well-being. Boosting your body with extra steroids is an effective way in reducing inflammation. Steroids have widely been used in the treatment of recurrent miscarriage and fertility conditions with varying degrees of success in outcome.

Prednisolone is prescribed to women with recurrent miscarriage or repeated failed assisted conception attempts in the presence of abnormal immune markers such as high NK cells.

The dose usually ranges between 15 and 25mg, and is taken after breakfast. When you have been taking this dose for 3 or more weeks, you will need to wean off the medication by dropping 5mg every 5 days.

Caution is necessary when prescribing prednisolone to patients with the following conditions: adrenal suppression and infection; hypertension, congestive heart failure, liver failure, renal impairment, diabetes mellitus, osteoporosis (post-menopausal women at special risk), glaucoma, psychiatric reactions, severe affective disorders, epilepsy, peptic ulcer, hypothyroidism, history of steroid myopathy.

Prednisolone is compatible with each trimester of pregnancy. Steroids vary in their ability to cross the placenta; 88% of prednisolone is broken down by the placenta and inactivated, therefore very little passes to the baby. There is no evidence that corticosteroids result in an increased incidence of congenital abnormalities, such as cleft palate/lip.

The most common complication is difficulty sleeping at night. Gastrointestinal discomfort, headaches, nausea, altered mood, skin reactions, fatigue, increased weight.

Other Uncommon Side Effects Include

Gastro-intestinal effects include dyspepsia, peptic ulceration, abdominal distension, acute pancreatitis, oesophageal ulceration and candidiasis.

Musculoskeletal effects include proximal myopathy, osteoporosis, vertebral and long bone fractures, avascular osteonecrosis, tendon rupture.

Endocrine effects include adrenal suppression, menstrual irregularities and amenorrhoea, Cushing’s syndrome, hirsutism, weight gain, negative nitrogen and calcium balance, increased appetite, increased susceptibility to and severity of infection.

Neuropsychiatric effects include euphoria, psychological dependence, depression, insomnia, increased intracranial pressure, psychosis and aggravation of schizophrenia, aggravation of epilepsy.

Eye effects include glaucoma, papilledema, posterior subcapsular cataracts, corneal or scleral thinning and exacerbation of ophthalmic viral or fungal disease.

Other side-effects include impaired healing, skin atrophy, bruising, striae, telangiectasia, acne, myocardial rupture following recent myocardial infarction, fluid and electrolyte disturbance, leucocytosis, hypersensitivity reactions, thromboembolism, nausea, malaise, shingles, hiccups.

Further Information: Please be aware that steroids can mask the common symptoms of pregnancy, such as pregnancy sickness.

Wellbeing blood tests are required at 3 monthly intervals.

Aspirin

Aspirin is one of a group of drugs called non-steroidal anti-inflammatory drugs (NSAIDs). It’s widely used to relieve mild to moderate pain and inflammation. It is also widely used in pregnancy for different indications such as reducing the risk of miscarriage, pre-eclampsia, and baby’s growth restriction in women at high risk of these disorders.

In our experience, Aspirin has been shown to reduce the risk of miscarriage, irrespective of outcome of the thrombophilia investigations. It is also used by fertility centres for women undergoing fertility treatment (IVF).

The low dose aspirin we recommend is 75 mg to be taken daily between 6-9 pm after food. Usually, the medication is taken until 20 weeks of pregnancy, but depending on the individual risk of preeclampsia (high blood pressure in pregnancy), the dose may be increased to 150 mg from 12 weeks gestation and continued until 36 weeks.

Not advisable to take if you suffer from asthma, stomach ulcers, known bleeding disorders,
or have mild to moderate renal/hepatic impairment.

Use of low-dose aspirin at any stage of pregnancy has not been associated with harmful effects.

Generally mild and infrequent, but in hypersensitive patients, side effects can include indigestion, heartburn, bloating, gastrointestinal upset with slight asymptomatic blood loss. In severe cases, it can cause an asthma attack and in rare cases, some skin reactions.

GCSF

Granulocyte-Colony Stimulating Factor (G-CSF) is a cytokine (molecules that aid cell-to-cell communication in immune responses and stimulate the movement of cells towards sites of inflammation) that stimulates neutrophilic granulocyte proliferation.

Found to possibly reduce the risk of miscarriage. Based on research trials, G-CSF has been shown to be safe and well-tolerated for mothers throughout pregnancies and for newborns without signs of abnormality. No noticeable side effects were reported.

In certain studies, G-CSF was used in a series of women with unexplained recurrent miscarriage in whom previous treatment with other therapies had failed. It showed G-CSF to be effective in recurrent miscarriage. In one particular study, 29 out of 35 women delivered a healthy baby, whereas in the placebo group, this figure was 16 out of 33. However, further studies are needed to confirm the effectiveness of this treatment in women with unexplained recurrent miscarriage.

The 300 mcg injection is for subcutaneous use. Your doctor will provide instructions on the timing of the injections in line with your treatment plan.

  • Bone pain in areas such as your pelvis, back, arms, or legs.

  • Headache, red or itchy skin (especially around the area where the injection was given).

  • Fever and chills. Over-the-counter painkillers, like paracetamol, can help reduce your temperature and prevent chills.

  • Swelling of the ankles or legs due to fluid retention, which, if severe, could cause breathlessness.

You will need to have a blood test to check your full blood count every 2 weeks whilst on this medication.

Adalimuab

Adalimumab is a TNF blocker, which is used for patients with elevated levels of TNF cytokines or Natural Killer (NK) cells, such as connective tissue disorders. It has been recommended and clinically beneficial in some patients with immune disorders associated with high TNF (tumor necrosis factor) levels.

The women at risk show alterations in CD56+ natural killer cells that secrete tumor necrosis factor. There have been no large studies done on patients with recurrent pregnancy loss or infertility, but several peer-reviewed publications have shown benefit in such conditions.

In cases of high TNF alpha: IL-10 and/or high INF-gamma: IL-10.

Two 40 mg subcutaneous injections: one at a time, 2 weeks apart. Occasionally, this course may be repeated if the TNF alpha: IL-10 or INF-gamma: IL-10 level is still high following the initial two injections.

Predisposition to infection.

Rash, nausea, vomiting, gastric disturbances, infections, headaches, rashes, and shingles.

Adalimumab has been shown not to cause fetal harm and is considered safe in pregnancy if used prior to 32 weeks’ gestation.

  1. If you are satisfied with the information given and have made an informed decision, you will be asked to complete a consent form prior to the arrangement of the prescription.

  2. Once the Adalimumab is received, the first injection can be self-administered, and the other injections stored in the fridge. Adalimumab can be given at any time in your cycle as a subcutaneous injection in the stomach or thigh area.

  3. The second injection is to be administered 2 weeks later.

  4. A further blood test for TNF alpha (HS5) may be needed and arranged after a minimum of 2 weeks following the second injection.

  5. A follow-up appointment is to be made with Professor Shehata 1–2 weeks after the blood test.

All patients, prior to the Adalimumab injections, will have a TB Gold Quantiferon test to ensure that this is negative.

If this is inconclusive, we will need to repeat the test. If TB is positive, then the patient may be referred to a chest physician for assessment and possible tuberculosis treatment prior to receiving the medication.

The TB test takes 5–7 working days to return, after which we will inform you of the result.

Thank You!

Thank you for reaching out to us and completing the enquiry form on our website. We appreciate your interest in our services and understand the importance of this journey for you.

Our team is dedicated to providing you with the support and care you need. One of our specialists will review your enquiry and get back to you to discuss your needs and answer any questions you may have.

We look forward to assisting you and being a part of your journey towards building your family.

Professor Hassan Shehata

Professor Hassan Shehata is a Consultant Obstetrician and Gynaecologist, specialised in Maternal Medicine at Epsom and St. Helier University Hospitals NHS Trust. With an extensive CV, he has contributed his expertise to various hospitals within the UK, building a wealth of experience in obstetrics and gynaecology.

In addition to his diverse clinical background, Professor Shehata is the CEO and Medical Director of the CRP Clinic. He has a wealth of global health contributions including reducing medicalisation of Female Genital Mutilation. He has dedicated his professional life to investigating and treating recurrent miscarriages and addressing challenges associated with failed IVF attempts.