https://www.rcog.org.uk/news/blog-international-day-of-zero-tolerance-for-fgm/
https://www.rcog.org.uk/news/blog-international-day-of-zero-tolerance-for-fgm/
Myself and my husband would love to let you know that I had my son on 14/12/2022 at 10:54am weighing 8lb 2 at St Peter’s Hospital.
I would like to thank you, all the nurses, Dr Edge and Dr Shehata for your help during this pregnancy. Dr Shehata said my killer cells were one of the highest he has seen and with the help of Intralipids and the medication, I have carried by little miracle.
I had 3 rounds of IVF and 3 miscarriages to get there and I believe I wouldn’t have my miracle without the medication and support given from CRP and Dr Shehata (who is a blessing as you look into reproductive immunology). We hope to see you in the future for baby number 2 as we have frozen embryos in our Cyprus IVF clinic/ will get in contact to try naturally beforehand with the help of the medication that got us our little miracle.
Many thanks
We wanted to get in touch to let you know about the safe arrival of our precious little girl – B.
As you’ll know we were having real struggles when we arrived at your door. From our first appointment we knew that we had found the right group of people to help us through one of the most challenging times we have faced. The whole team at CRP could not have given us a warmer welcome and been more reassuring – we left our first consultation with a sense that reaching our goal of family life was absolutely achievable.
B arrived a little early and weighed in at 6lb 4oz….small but with a mighty set of lungs. At 8 weeks old she is absolutely thriving and bringing so much joy to our lives and to those of our family too.
We cannot thank you enough for everything that you have done for us. It really is life changing stuff and we will be eternally grateful to you all that we are able to experience parenthood thanks to the work that you did with us.
Huge love
A, I and B xxx
After three and a half years of recurrent miscarriages and a termination on medical grounds, my husband and I came to CRP hoping for help. Mr Shehata performed tests and created a plan for me. Sadly, I suffered another miscarriage but karyotyping showed it was a ‘true’ miscarriage (as opposed to an autoimmune one) so we decided to have one last attempt at a baby. I fell pregnant shortly after and the pregnancy seemed to stick. Professor Akolekar promised me the baby was looking anatomically good at the 14-week scan and that I could relax into the pregnancy. I did and it was all straight forward until the 28-week mark. I had a growth scan with Professor Akolekar and he reassured me that the baby was growing well and still sound, but my cervix had effaced and I was actually in labour. The clinic was quick to get me to Epsom hospital for a second opinion. They agreed and I was given all the medication required in an attempt to stem labour and prepare the baby for his imminent arrival. I was then transferred to St Helier’s, where the NICU was equipped to deal with the early gestation. The doctors managed to stop labour and, after 2 days, I was moved to the antenatal ward and given a room and put on bedrest. It was an anxious time for me, so far away from my two older kids and unsure of the future for our baby. We managed to hold back labour for almost a month and our baby was born at 31+5, just shy of the moderately preterm mark, but fully prepared thanks to steroids for his lungs and magnesium for his brain. He was born quickly on 29th November 2021 by emergency c-section and had no need for oxygen. Again, thanks to the efforts of everyone, Ralph was a “feed and grow” baby – needing no real intervention, just time with tube feeding and an incubator. We transferred back to our local hospital at 34 weeks and he was discharged on Christmas Eve – a wonderful and emotional early present. A slight relapse saw us back in hospital over New Year, but since then he has grown and flourished, particularly since weaning! This boy loves his food.
We would like to express our gratitude to Mr Shehata and Professor Akolekar. It would be easy to dwell on the difficulties of pregnancy and birth, but in truth we were so lucky with our outcome.
Here is a picture of Ralph, at 9 months old – 7 months adjusted – on holiday. He’s a real smiler – just happy to be here with his family!
Warmest wishes,
Caroline and Jonathan
Back in November 2017 we started trying for a baby . Soon after we found out we was pregnant on Valentine’s Day 2018 and a few short weeks later we went on to have our first miscarriage. Four more miscarriages followed from 2018-2021. After the third miscarriage we got referred to the recurring miscarriage clinic where we had very basic tests done, the results showed nothing. After the fifth miscarriage I started looking into testing for NK cells. I found a fertility clinic that did this by a biopsy (endometrial scrape) the results came back as inadequate so I had it re done and it came back inadequate again ! (When we came to the CRP clinic dr Shehata told me that test should of never been done like that as it’s not accurate and the only way to test for NK cells is by blood test). I also looked into Tommy’s and got a referral there but they wanted me to take part in a 3 month trial and we didn’t feel like we wanted to waste time on a trial , we just wanted answers and a treatment to why this was happening.
I wrote on a forum saying I was lost and didn’t know where to turn to next and a few women then mentioned dr Shehata at the CRP clinic. I started researching him and seen so many success stories of couples who were like us. I didn’t waste any time and got booked in for our first appointment. The minute we got to the clinic we felt very welcome. Dr Shehata said to us there is many reasons why miscarriage happens and when he told us that I knew he was the man who was going to get us our baby. All we had been told by the nhs constantly was that miscarriage was one of those things ,so hearing dr Shehata say there is many reasons why miscarriage happens was such a relief. He scanned me on that first day and told me I had PCOS (I had over 17 internal scans with the nhs and this was never mentioned). I had all the blood tests done that dr Shehata said and we went back two weeks later for the results.
My results showed I was boarder line high for activated NK cells. I also had another scan that day to check my lining of the uterus and it was too thin. I was put on a treatment plan of quite a few tablets which you have to be on for 3 months before you can try. And in august we got the go ahead to try. In December 2021 we found out we was pregnant. Rang the clinic and was told to go down to have my first intralipid infusion drip. I had these every 4 weeks till was 16 weeks pregnant. And scans every 2 weeks till 16 weeks. Every time we got into the car to make the journey to Epsom which would take us 4 hours . We would both drive in silence as we was both so anxious of each scan and the pregnancy failing again. But once we got to 10 weeks dr Shehata said the chance of miscarriage now was very very low. All our other pregnancies ended at 6 and 8 weeks so to even get to 10 weeks was amazing ! We soon got to 12 weeks and had a really in-depth scan with the professor. He actually told us we was having a boy that day. Once we got to 16 weeks we were discharged from the clinic and came off a lot of the tablets then. I was nervous coming of the tablets and not going to the clinic anymore but we was consultant lead so we got a lot of scans with the nhs. From 28 weeks we were scanned weekly and at 33 weeks and 2 days we was told the umbilical cord blood flow was irregular. I had to have steroid injections 24 hours apart to prepare the babies lungs. And a scan at 33weeks and 5 days they told us he needed to come out so got rushed down for an emergency c-section. Our baby Jenson was born on Friday 15th July at 1:41pm weighting 4lb4. Even lying on the operating table we still couldn’t and didn’t dare believe we was having a baby. It wasn’t until we heard him cry that we both then cried with joy and relief. Jenson was taken to the nicu with being born 6 weeks early . He spent a week there but was only on the oxygen for 24 hours and was literally only in there so long because he was early and so small . The day we got to take Jenson home was amazing. I still don’t think it’s fully sank in that we’re parents now and we actually have our miracle.
It still feels so surreal and if it wasn’t for the amazing work that dr Shehata and team do at the CRP clinic we wouldn’t have our little boy . I can’t thank you enough . You have made our dreams a reality and We will forever be great full.
Leanda potter and John Tuck
After 4 heartbreaking miscarriages in 2019 and 2020, one of which required surgery, a friend recommended we visit Mr Shehata as he had helped them have a baby after a similar journey of heartache and loss.
Mr Shehata did a thorough assessment of our medical history and fertility journey so far. He seemed confident he could help us and sent us both for various tests. He has an impressive track record and success rate therefore we felt that if anyone could help us he could.
The tests revealed that I had a high level of natural killer cells which were very active. This explained why I had lost previous pregnancies as my immune system was fighting them off. It felt good to finally get answers and to be told it would be possible to have a baby. Part of the testing assessed what levels of drugs I would require to help maintain a pregnancy so the treatment plan was tailored specifically to me.
I started a treatment plan of prednisolone and intralipids, along with aspirin, omeprazole and progesterone. It felt good to be taking the medication as it felt like a proactive step forward. Mr Shehata was confident and that gave us hope.
Unfortunately we had another miscarriage at the beginning of 2021 which the CRP were not expecting and booked me in for an Manual Vacuum Aspiration (MVA) procedure. Following this I also had a hysteroscopy due to weeks of unexplained bleeding. Mr Jan completed the procedure and identified that I had Ashermans syndrome, likely from the D&C I had after my first pregnancy. Mr Jan was a huge support during this process and I felt very safe under his care. Again it was good to get answers as to why I had miscarried and know that the scar tissue had been removed so we could try again.
It felt like the CRP team were as determined as us to help bring us our baby.
Having cleared the scar tissue we were ready to try again and this time Mr Shehata added in an additional drug to the plan – Hydroxychloroquine.
In September 2021, we fell pregnant again. We were petrified at the first scan but Mr Shehata didn’t delay and started the scan immediately. He quickly told us there was a heartbeat and everything looked good. He is such an expert in his field that we hung on his every word and felt instant relief. The care we received over the following weeks was excellent and the midwives were so empathetic and supportive.
We had wondered whether it would ever be ‘our turn’ to have a baby and so we were still in shock when we made it to 16 weeks and I had weaned off the medications.
On the 7th June our healthy happy baby girl was born weighing 7lb 4oz. She is our miracle baby and has bought us immeasurable joy! Our hearts are full and we feel incredibly lucky that we found Mr Shehata and team who helped us have the baby we began to think would never be part of our future.
We will be forever grateful to Mr Shehata, Mr Jan, Ms Viswanatha, Geraldine, Laura and Nicola! We hope that others who have had similar journeys find their way to the clinic and get the support and treatment we were so lucky to receive.
Before coming to CRP clinic we had a long road of heartache.
Back in 2016 & 2017 we had two miscarriages, the first of which was very traumatic. Later on in 2017 we fell pregnant a third time and we were lucky enough to have a miracle baby boy and naively thought we were fixed and miscarriages were a thing of the past. Our son Isaac was born in June 2018 and we were over the moon.
A year or so later we thought about trying again to complete our family. Unfortunately history began to repeat itself and we went on to have a further 4 miscarriages in 2019 & 2020 one of which required surgery and each miscarriage became more traumatic.
We tried to seek help with the NHS as we had now had 6 miscarriages but were told as we had, had a healthy baby they would find nothing wrong.
After feeling we could take no more we contacted the CRP clinic. Mr Shehata instantly put us at ease and I left the first appointment saying to my husband ‘that will be the doctor that gets us our baby’.
After all our tests it was found I had a high level of natural killer cells and I started treatment of Hydroxychloroquine and intralipids, along with aspirin and progesterone. It was a lot to take in but Mr Shehata filled me with confidence and hope. In the back of my mind I was worried what if I was the person it didn’t work for, but I didn’t need to worry.
We fell pregnant our second cycle of trying. Our first scan I was absolutely terrified but he just got straight on with it and said straight away ‘there’s your baby’s heartbeat’. I’ve never felt such joy and relief. By week 10 he explained our chances of miscarriage were now very low and to start enjoying the pregnancy.
I couldn’t believe we were finally getting our wish and found it hard to relax during the pregnancy. On the 12th May 2022 our baby girl Orla was born weighing 6lb 5oz. She is perfect and has completed our family. This time last year I would’ve never believed that I would have our rainbow baby. I’ll be eternally grateful to Mr Shehata and everyone at CRP, thank you for saving me from further trauma and mostly importantly for our baby girl.
Rebecca & Steven
In 2019 we had our daughter without any issues, however we subsequently experienced difficulties when trying for our second child. While able to get pregnant, we unfortunately had a number of miscarriages which were heartbreaking for our family.
After finding the CRP clinic online, and reading the testimonials from others individuals who had experienced similar problems to us, we decided to make an appointment. Doctor Shehata and the team were very knowledgeable, and it was very comforting to understand why previous pregnancies had been unsuccessful and that treatment was available. We have no doubt that this helped us to welcome our son in 2022. We are very grateful to the whole team.
Kind Regards,
Hayley & Piers
Fetal Medicine scan packages are available on request.
IUI packages are available on request
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
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 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 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.
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 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 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 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.
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.
You will need to have a blood test to check your full blood count every 2 weeks whilst on this medication.
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.
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.
