Clinic News
& Fertility Insights

Every fertility journey is different. Explore real patient success stories, supportive guidance and updates from the CRP Clinic team, designed to help patients feel informed, reassured and supported throughout treatment.

I met Mr Shehata,11 years ago when me and my husband had been trying for a baby. I have two children already now 18years and 15 years, but ever since me and Alan had tried for a baby I kept having miscarriages, all at 8 weeks it totally broke our heart. I have been seen by a number of Drs in different hospitals but carried on losing my babies, then I heard of Mr Shehata, my first appointment was made.

When I met Mr Shehata he made me feel at ease, you could tell he loved his work and had great pleasure in helping woman like me, and so my journey began. I tried asprin, heparin injection, progesterone, calcichew, intralipids. I had more miscarriages though all at 8 weeks then I carried a baby. We had scan at 11weeks and saw the baby moving around. Mr Shehata cheered he was over the moon, I was happy but scared, kept thinking something would go wrong. It did, I lost my baby at 15weeks. That was my 19th miscarriage.

I carried on seeing Mr Shehata, I then lost a little boy at 5months had to go in hospital to give birth then have a funeral, I was totally destroyed at this point but couldn’t give up. After I lost my son the drive to London seemed so much longer then 2 hours,Mr Shehata gave me a new drug which I started taking for over a year as daily routine, I fell pregnant and found out September 2012 I was so sure I would lose my baby again.

I didn’t tell anybody, then Christmas came and went then it was a new year 2013. I managed to hide my bump with baggy tops was so scared every day, on January 4th I decided to phone and ask for a scan. I had one the following day at 8.30, I was waiting for the words im sosorry Kelly theres no heartbeat, those words didn’t come I was told baby looked fine, I was yet again so scared thought I had jinxed myuself and would lose my baby. I was booked in at antenatal, every scan I feared the worst.  My baby boy was due the 19th June 2013, but April the 1st my midwife came to do a check. I had high blood pressure and protein and was sent to hospital and kept in. On the 3rd of April at just 29 weeks I was told my baby had to be delievered as I had pre eclampsia and kidney failure.

I knew now I would lose my baby after how far I had come, at 3.51am my son was born through c.section weighing in  at 2ibs 15oz he let out a tiny cry as he came into the world, I was so poorly I didn’t see him for 2 days then when I was wheeled down to the neonatal unit I broke my heart I seen the smallest baby I had ever seen in my life. I honestly thought then I would lose him , at 6weeks 3days on the 18th of May my baby boy was allowed home from hospital, such a proud day of my life.  He is now 11lbs 11oz, 17weeks 5days, but correct age he is 6 weeks 5 days. I can not thank Mr Shehata enough for giving me hope and never giving up on helping me. He is the most amazing Dr you could ever wish to meet, after 11years of waiting, 20 miscarriages and 11 weeks early my baby arrived and is doing fantastically. Thank you so so much to a lovely man – Mr Shehata he has made my, my husband’s and my two daughters’ lives complete.

It was December 2007 when my husband and I decided that we’d like to start a family.  Little did we anticipate the long journey ahead of us…

After two years of trying to conceive naturally without success, tests on both of us; endless blood tests to see if I was ovulating; temperature charting etc. we were told that we fell into the category of “unexplained infertility”.

We embarked on our first round of IVF in 2010 and were able to produce a good amount of strong and healthy embryos.  Having gone all this time without managing to conceive I think we almost looked at IVF as some kind of ‘prescription’ that was going to solve the problem and bring us the baby that we longed for.

We got to blastocyst stage and had the strongest two embryos put back.  When this didn’t work we were devastated but were told and were aware of the fact that statistically there was more chance of IVF working the second or even third time around.

However, these second and third attempts came and went and still no success.  Each time, we were always able to create a good batch of healthy strong embryos, and each time, the ones put back never implanted.  The clinic where we were receiving treatment gave us very little in terms of how to proceed differently with each cycle and we felt like we were just a ‘number’ without any personalized care or attention being given to our situation.

We were told that we had to look upon each round of IVF as ‘another month of trying to conceive’ and that statistically our chances would increase with the more attempts we embarked upon and to ‘just keep going’.  I remember feeling very empty and dissatisfied with each follow up appointment after an unsuccessful round of treatment and it really started to take it’s emotional toll on both of us.

By mid-2011 and not being satisfied with ‘statistics’ any more and still having no real reason for us not being able to conceive, we started to look down other avenues and other places for treatment.

The wife of a colleague of my husband fell pregnant (who had repeated miscarriages) following treatment under Mr. Shehata in connection to both The Miscarriage Clinic and New Life Clinic.

When I looked at the New Life Clinic website, everything it was telling me rang true of our situation.  Although I had never actually become pregnant, subsequently never suffered a miscarriage, failure to conceive for no apparent reason and in our circumstances, failure for our embryos to implant was viewed upon in a similar way, almost like a ‘mini miscarriage’.

We went to see Mr Shehata and following some simple immune system blood tests it transpired that I had very high activity Natural Killer cells which could possibly be the cause of the problem, attacking any healthy embryos.  The very fact that someone had actually taken the time to pin point a ‘potential’ reason for our ‘unexplained infertility’ was a huge lift and filled us with a new found hope that had very much started to fade.  Finally, someone was paying attention to us as individuals, rather than just another number!

So, armed with a variety of drugs and steroids aimed at suppressing my NK cell activity, we set about our fourth attempt of IVF with the assistance of Mr. Shehata.  The cycle of IVF itself was still carried out at our original clinic as we were still entitled to NHS treatment.  However, once again it was unsuccessful.

To describe how crushed we were at this stage is almost impossible.  We had pinned such huge hope on being successful this time, especially as we were targeting what seemed to be the cause of us not being able to conceive.  When we went to our follow up appointment with Mr. Shehata it was all I could do to hold it together emotionally.

We were ready to give up, we couldn’t take any more physically and emotionally – infertility had beaten us and we were never going to have our own biological child.  In my mind and in my heart I was already thinking about finding other ways to become parents, with adoption becoming more of a possibility.  I will never forget for the rest of my life what he said to us. Just three simple words, looking me straight in the eye: “don’t give up”.

After much soul searching we decided to give it one more shot: our fifth and final attempt at IVF.  In our minds we had always had five as the number of attempts we would try, mainly because it was generally perceived that after five attempts the chances of conceiving are very small.  However, because we were so mentally and physically exhausted by this stage, numbers almost didn’t really come into it any more.  Although we were gearing up for this fifth and potentially final attempt, we were so beaten down by and used to disappointment that our hearts weren’t really in it.

We were then referred to Mr. Gafar at New Life Clinic who, during our initial appointment, recommended that before embarking on our fifth cycle,  (which we were now going to carry out completely with New Life) I could try taking the drug Humira, which we were told could help us conceive naturally and that some people fall pregnant naturally by just taking it without the need for IVF!

It was thought that in our situation, it could help calm down NK cell activity and prevent embryos from being attacked that were trying to implant.

In my mind I was thinking this is the kind of luck that happens to other people, not to us, and sure enough, my blood tests showed that it had in fact increased my Cytokine levels even further!  Although we were told this was common on first taking it, it still just left us feeling disheartened… how much more could we take?  However, on New Life’s advice, we decided to give the Humira one last shot before our IVF cycle… why not…

I will always remember that morning.  I’d been feeing a little different… my period was a couple of days late, and I was used to a lot of spotting before any bleeding which hadn’t yet happened. However at this point this still meant very little in terms of getting our hopes up. I decided to take a pregnancy test.. it was a Sunday, I didn’t tell my husband what I was doing, after all, I had taken countless tests before, what was so different this time?  So used to seeing a negative result and why get his hopes up? So when those two blue lines appeared, to say I couldn’t believe my eyes is an understatement!  A few seconds went by when only I knew, only I could see what was happening.  After sharing the news with him, we were both in absolute shock and I remember us just sitting on the bed bewildered, just staring at the positive test in disbelief!

After some further treatment at New Life Clinic to help us hold on to the pregnancy, I am delighted to be writing this with our dear little son lying sound asleep next to me.  It seems that the Humira had appeared to completely ‘re-set’ my system, enabling my body to allow a naturally conceived embryo to implant.

To think that after all these years we didn’t even need IVF treatment in order to conceive.   We have finally realized our dream of becoming biological parents.  I can honestly say that if it wasn’t for the help of Mr. Shehata, Mr. Gafar and New Life Clinic we wouldn’t be blessed with our little miracle, and for this we will always be deeply grateful.

His little hands were curled into perfect circles, and his features were recognisably those of his father, but our son, William Brighton Clover would never open his eyes and see the world.

Thanks to Dr. Shehata though, William’s loss did not remain unexplained and his baby sister is now lighting up our lives.

William died in utero on July 26th 2010 after an uneventful pregnancy when I had not suspected for a moment that there was anything wrong. He was 22 weeks old, which meant that I had to go into hospital and go through labour without the joyful prospect of a baby at the end of it.

The experience was traumatic, extremely frightening. I was 36 when we lost our first baby, but NHS tests did not find any reason for his death. Nevertheless I was determined not to leave any stone unturned before trying for another child. I couldn’t take the risk of losing another life so late along in a pregnancy and having to go through labour again or finding the remainder of my fertile years taken up with repeated miscarriages.

I read an article by Dr Shehata in the Daily Mail, and am so glad I stumbled across it. Dr Shehata believes that the majority of recurring miscarriages have an undiagnosed cause.

After a brief and friendly appointment and a few blood tests I was surprised but heartened to realise that there was a reason we had lost William. I suffer from two conditions that make it difficult to carry a baby to term. Firstly, my body does not absorb folic acid properly – I suffer from the MTHFR gene mutation – which means I need 12 times the recommended does of folic acid during pregnancy.

Furthermore, I have a high count of Natural Killer cells, which are toxic to the placenta, and likely caused me to miscarry William so late, as he began to grow faster and needed the placenta to work harder.

To conceive the second time, I had to take aspirin, extra folic acid, progesterone, and steroids to dampen down my immune response and have monthly intrallipid infusions, which meant flying back to London from Moscow where we live for the intravenous treatment once a month till I was 5 months along, but all the effort was paid off and our reward was a beautiful daughter.

Jaya Sarah Clover was born on August 2nd 2012, and she is a bouncing giggling bundle of joy. After the trauma of losing William, to have successfully had a perfect healthy little girl really feels like a miracle.

We were over the moon when I first fell pregnant just months after our wedding. Nine weeks later we were told that the baby had stopped growing at around six weeks. We were utterly devastated but remained positive that things would be successful next time. Again, I fell pregnant quickly only to be told at an early scan that the baby had stopped growing again at six seeks. At this point we were still hopeful that the miscarriages were bad luck and we must be due some good luck soon. Sadly, my third and forth pregnancies ended the same way and, after having every test available on the NHS, no reason could be found for our losses. ‘Just bad luck’ we kept being told by doctors.

My miscarriages all followed a very similar pattern and we had a feeling that something was causing them other than just bad luck. I knew that someone must be able to give me some answers and spent hours searching the internet. It was in May last year that I came across Mr Shehata’s clinic.

It was the first time in a long time we felt a glimmer of hope. Mr Shehata said he would try to find a cause for all our heartbreaking miscarriages. He quickly discovered I had a very high level of NK cells and recommended a treatment plan of steroids and intralipids. We were so relieved that finally someone could give us some answers and offer me a treatment plan.

When I became pregnant for the fifth time, we were still very anxious but had faith in Mr Shehata and the treatment I was on. I will never forget the first time he scanned me and we saw a tiny flickering heartbeat on the screen. We had never got that far with our other pregnancies so it was an amazing feeling and a huge milestone in our long journey to become parents. One positive scan was followed by another and finally we started to believe that we might actually have our long awaited baby.

I went on to have our beautiful daughter Ella in July, just over a year after I discovered Mr Shehata. Along with his fantastic team, he gave us hope and support throughout my pregnancy. I am eternally grateful to him for helping us achieve our dream of having a family.

Kate

We had been trying to conceive for 4 years before visiting Mr Shahata at the Miscarriage Clinic.  We first visited our GP after 9 months of not conceiving and were given 3 months of Clomid as both our fertility levels were on the lower levels of acceptable, without success.  We were then referred to an NHS specialist who suggested we tried increasing the dosage of clomid and after a couple of months I fell pregnant, but sadly the pregnancy did not last and I had an early miscarriage at just over 5 weeks.  We were told that it was just one of those things and to continue taking the clomid for a further 7 months.  When I had failed to fall pregnant again we were referred for IVF treatment.

The first treatment did not result in a pregnancy despite having good results all the way through the treatment the 2 healthy embryos failed to implant.  It was then decided that I should be given low levels of anti rejection drugs with the next IVF attempt, which was a low dose of Prednisolone and some clexane to thin the blood.  We were delighted when we got a positive pregnancy test and all the initial results were good.  We decided to have a scan privately at 9 weeks as I knew the percentage for miscarriage falls dramatically if a healthy heartbeat is seen at this stage.  However although the scan at 9 weeks showed everything to be normal I was diagnosed with a missed miscarriage at my 13 week scan, as this had showed the heartbeat had stopped at about 9 weeks and 3 days.  Once again we were back at the beginning with the added stress of knowing I had miscarried twice without any answers as to why.  I decided to take a blood test to show my levels of natural killer cells which came back extremely high and it was then suggested I contact Mr Shehata at the Miscarriage Clinic for treatment for this to be taken along with my last try at IVF.

Although there was finally a probable reason for my miscarriages my husband and I  very stressed and nervous by the time we met Mr Shehata, but found him to be extremely understanding and reassuring.  He constantly maintained that given the right treatment my chances of conceiving would be good.  I found his confidence and positivity vital in my attitude to having a further treatment of IVF combined with treatment for my natural killer cells.  I was prescribed a course of high dose Prednisolone and Clexane along with IVIG.  We were thoroughly delighted but a little anxious when I once again had a positive pregnancy test, but this time I was constantly monitored by Mr Shehata and we were thrilled to find out I was expecting twins.  I saw Mr Shehata every 2 weeks for the first 16 weeks and once we were out of the danger period I then was discharged by him and we continued to be monitored in the normal way by the NHS.  I do believe that I would not be the mother of 2 beautiful and amazing babies if I had not been treated by Mr Shehata.  He had the right level of monitoring without being too invasive and I always believed that I could contact him at any time should I have any serious worries about my pregnancy.  I was lucky to have a problem free pregnancy with very little side effects from the treatment and our babies were born totally healthy at just over 37 weeks.  I would recommend Mr Shehata to anyone who is having difficulty in conceiving as I believe he has changed my life in giving me the family I always wanted.

I already have a daughter who was born in 2001 – my pregnancy with her was very normal and she arrived at 37 weeks after a very normal and quick labour. I then found that I was pregnant in 2007 – completley unplanned but delighted nevertheless. At around 10 1/2 weeks, I started to bleed – just light spotting – as I was due a scan in the next week, I decided to leave it. By the time the scan date arrived, I knew that something was wrong as the bleeding was heavy now. I was right, there was no heart beat and we were told that the feotus was at the 7-8 week stage when it stopped developing. We were told by the doctors that ‘it was one of those things’ and given the statistics on the number of women that miscarry. We were devestated, but still hopeful. Three months later, I fell pregnant again – this time with no bleeding and having started suffering for morning sickness we went to our scan appointment full of optimism. We were shocked to find again that there was no heartbeat – in complete disbelief. Again, the feotus was showing to be at the 7-8 week stage. After having a D&C, I visited my GP to get some answers, but was again told the same as before – one of those things. Under the NHS, investigations are made only after 3 miscarriages. We were exhausted both emotionally and I physically so we decided to leave things for a while. In Novemeber 2009, I fell pregnant again, but started bleeding immedietly and after a very early scan at the EPU, it was confirmed that we had lost another pregnancy. I didn’t think I could do this again. My partner and I had a blood test to check for chromosones – all was ok. Still no answers.

My partner, decided to take things in his own hands and began researching alternatives on the internet and this is how we stumbled across Mr Shehata. There was a clip of him speaking on Richard and Judy – he was saying something different. It wasn’t just one of those things – there could be reasons and ways to prevent miscarriages. We didn’t hesitate and made an appointment for our initial consultation. This was made easier as Mr Shehata had various clinics and so we were able to choose where to go depending on location and availability.

When we first met Mr Shehata, we were struck by how positive he was about us having a successful pregnancy. He talked us through the possible reason for my miscarriages as being due to a high killer cell. I was unsure as I had had such a normal pregnancy with my daughter, but Mr Shehata explained how this could occur. I went along for some blood tests and after a few weeks returned to see Mr Shehata to discuss the results. It seemed that my killer cell was very high and so could have been the cause for the miscarriages. He explained the treatment, which was very simple. We couldn’t quite believe that he was so positive.

Soon after, I feel pregnant again and we arranged an appointment for a scan at 6 weeks. All was well but it was after this stage that I had lost the previous pregnancies so I was stilll very anxious. We continued to see Mr Shehata every fortnight for scans and we couldn’t believe that we had got to 10 weeks and everything was still ok. I’ll be honest, I never did stop feeling anxious, not until I held our little son but having those regular consultations really did help put my mind at rest. We continued to see Mr Shehata until I reached 16 weeks. I would have continued, but he assured us that we didn’t need to but could if we wished. His confidence was very reassuring.

Due to having had three miscarriages, I was eventually referred to an obstetrician through the NHS and so after my 20 week scan, I also had scans at 24 and 30 weeks – this added to my reassurance. Seven and a half weeks later, our beautiful boy was born after a very normal and quick labour. We really couldn’t believe it. I think we had both not really wanted to imagine what it would be like to hold him because we didn’t want to build up our hopes. So, when he arrived, it just felt unbelievable. We had our little boy and our daughter had her little brother that she was so desperate for.

We completely believe that he is here because of Mr Shehata’s treatment. This last pregnancy was our last chance – I didn’t think that we could have coped with another loss as we are all getting older! We can’t thank Mr Shehata enough and hope that by sharing our story and making people aware of this could save a lot of heartache.

…having had 4 miscarriages we read about Mr Shehata and were amazed and decided to go and see him ourselves. He carried out several tests and a scan and we found I had polycysic ovaries and nkc cells which i was given treatment for and a follow up appointment.

On our return it was discovered i was pregnant, expecting a little boy who was born 23 Dec 2010 and is our little miracle baby. We would recommend Mr. Shehata to anyone and everyone experiencing difficulties.

Shortly after getting married I suffered 3 miscarriages within 10 months of each other which cast a shadow over our happiness together. As I belong to the medical profession it was easy for me to be seen by several specialist doctors who told me that all was fine with me and that it was just a case of bad luck.

The first time that we saw Mr. Shehata I was feeling really depressed, inadequate as a woman, confused and pretty sure that I wouldn’t be able to have a child. He listened to us with a lot of compassion and gave us hope when he mentioned that I could have a high NK cells count which could be the cause of my pregnancy losses.

When he confirmed his suspicions a couple of weeks later that I had a high NK cells count we began to see light at the end of the tunnel and decided that we were going to give the treatment a chance.

I started the treatment with steroids a couple of months after being given the result – we just wanted a bit of quality time enjoying each other’s company before the “big adventure”- and luckily I fell pregnant immediately.

As Mr. Shehata explained to me, the steroids gave me a few nasty side effects: insomnia, anxiety, a puffy face, constant sweating… but all was worth it when he did an ultrasound at 6 weeks and we could listen to our baby’s heartbeat for the first time… what a moment! We could only see a little “rice grain” moving furiously but we were so full of respect and pride for this brave human being growing strongly inside me.

I would be lying if I said that it was all a bed of roses, I was feeling very scared during the pregnancy – Whenever I had a twinge or a little cramp I was convinced that I was having another miscarriage. However none of the side effects, the morning sickness or even the labour pains were as painful as the sorrow of losing my babies,
so I don’t have any doubt that I would do it all over again the same way.

Even though the pregnancy was complicated and the birth wasn’t what I had planned for, we were blessed with our little baby boy who was born on the 28th May 2010.

We called him Nicolas, in part because it means “victory” and that is the way I feel every time that I look at him. I still can’t believe that he has come into our lives, everything is more colourful, brighter and full of laughter, and I have to pinch myself from time to time as I can’t believe how lucky we are!

We are so thankful to Mr. Shehata for helping us to experience the joy of parenthood. We believe so much in what he does that we are already planning a little brother or sister for our baby, and all of course under his guidance and support.

I specialise in problems in pregnancy and recurrent miscarriages. On Monday afternoon I was at my private practice. I see people from all around the world; by the time women come to see me, they are pretty desperate. One woman had had 21 miscarriages; she lost the majority of pregnancies in the first trimester, but also had about three or four in the second trimester. She was very upset, but I’m hoping to help her. Another of my patients had had eight miscarriages. She is pregnant and when she arrived, she was shaking. When I gave her a scan it was the first time she and her husband had ever seen their baby’s heart beat. It was very emotional, and it made my day. I love my job because often I’m bringing good news to people for the first time.

My research is on “natural killer cells”, where the body’s immune system attacks the pregnancy. I estimate it could affect a fifth of women who have recurrent miscarriages.

On Tuesday morning I have a diabetes clinic. With diabetes, babies tend to become bigger in the womb. If the diabetes isn’t controlled, it can cause the death of the baby. We had a woman who had been meticulous with her diabetes control and diet, but her baby was still getting bigger and we had to deliver the baby by caesarean section the next day.

On alternate Tuesday afternoons I do a recurrent miscarriage clinic or a preconception counselling clinic. We see patients from all over the country. One wanted to fall pregnant, but has systemic lupus erythamatosus (SLE), which is like rheumatoid arthritis, but can also affect the lungs and kidneys. I had to tell her I didn’t believe it was a good idea to become pregnant, which is always hard. Her disease is quite active at the moment – we need to control that first. A few years ago, I advised a patient with similar problems against pregnancy. She became pregnant and by 24 weeks she had severe pre-eclampsia. We had to do a very early caesarean because we were worried about her life. Her baby didn’t survive. It can be that severe.

On Tuesday night, I was on call. I’m not often called out, but the registrar had decided to do a caesarean section for a woman who had a high BMI and whose baby was stuck. It was very difficult – a routine caesarean takes 45 minutes, but I spent about three hours on this. Eventually the mother and baby were well.

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

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.

300400mg 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.