Current Covid19 Precautions

Merrion Fertility Clinic Covid19 Precautions Overview as at 31st July, 2020

In this article, we will outline the many measures Merrion Fertility Clinic has put in place for the safety of our patients, employees and members of the general public. We would like to acknowledge the distress that has been caused to so many fertility patients during the pandemic and assure you that we are taking every step to have you receive your treatment as quickly and safely as possible.

Footfall

Since re-opening in May, we have taken various steps to reduce the footfall in the clinic. We only bring patients into the clinic where absolutely necessary and we ask that partners do not attend. We stagger appointments and request patients not to arrive early. We have been very successfully conducting Doctor and Nurse consults via video link since March.

As soon as the pandemic began, we ensured that all staff had access to a laptop and were set up to work from home. This involved close partnership with our IT providers, as network security and data confidentiality is of the utmost importance to the clinic. Many of our staff need to be on premises to carry out their roles, but we continue to facilitate staff to work from home as much as possible.

PPE

All patients and visitors to our clinic are required to wear face masks. Our staff wear PPE at all times when interacting with patients. There are a number of hand sanitiser dispensers throughout the building.

When interacting with each other, our staff must either be wearing face masks or visors, or be two metres apart. Every office is equipped with disinfectant spray and tissues, and every desk has hand sanitiser. Each office has a set quota of staff that can be present at any one time.

Cleaning

We have always had rigorous cleaning standards but, since the clinic re-opened, we have employed a cleaner for additional hours each day to disinfect all areas that can be touched throughout the clinic.

Contact Tracing

Everyone who enters and leaves our premises is recorded for contact tracing purposes.

Triage Questionnaires

Our nurses run though questions with patients over the phone, including if they have been diagnosed with Covid 19, if they are experiencing symptoms and if they have been in contact with a confirmed case. We have recently started asking patients if they have returned from an international destination in the past 14 days. Those who have visited countries not on the Green List within the last 14 days will not be allowed to attend the clinic.

These questions will also be asked to all patients and visitors on arrival at our reception, and all visiting contract staff are required to complete the questionnaire in advance of arrival.

Our staff must also complete the questionnaire on a regular basis and must report any symptoms immediately.

Covid Testing

We are now Covid testing some patients and staff, if we feel this is clinically indicated.

Backlog

Because the clinic was closed on March 17th and we only re-commenced our main fertility treatments on May 25th, there has been quite a considerable backlog of patients. This has caused some frustration, for which we apologise. In addition, there are also delays to some surgical procedures in hospitals which are beyond our control. We are doing our very best to ensure our patients receive their treatment as quickly as possible.

Contact Us

If you have any concerns you would like to clarify, please contact us on email at info@merrionfertility,ie or by phone at 01 663 5000.

MFC Presence at the ESHRE Annual Meeting

Merrion Fertility Clinic was very well represented at this year’s ESHRE ( European Society of Human Reproduction and Embryology) Annual Meeting. The Annual Meeting, the largest of its kind in Europe, is traditionally attended by 12,000 international delegates with cutting edge science and research presented across the 3 day conference. With current Covid19 restrictions the meeting, originally scheduled to take place in Copenhagen, was converted to a virtual conference permitting attendees to watch the presentations from the safety of their own homes / workplaces.

Dr. Lucia Hartigan presented data obtained during her clinical research fellowship at Merrion Fertility Clinic, which aimed to identify new biomarkers of oocyte development potential. Investigating inflammatory proteins present in follicular fluid at egg collection, Dr. Hartigan found that low levels of interleukin (IL)-10 were associated with better oocyte fertilization and embryo development.

Research FundingDr. Lucia Hartigan

Dr. Fiona Reidy and Dr. Maebh Horan, also Clinical Fellows at Merrion Fertility Clinic, had their research presented in the format for a poster exhibition.

Continuing Dr. Hartigan’s research, Dr. Reidy further investigated the impact of inflammatory pathways in the female reproductive tract and their association with oocyte and embryo quality, which may influence IVF outcomes.

Dr. Horan’s research is focused on fertility preservation services available for male adolescents undergoing oncology treatment in Ireland. Merrion Fertility Clinic, in collaboration with Children’s Health Ireland, has now established the first structured national sperm freezing service for teenage boys undergoing cancer treatment.

Joyce Leyden, Senior Embryologist at Merrion Fertility Clinic, on behalf of ESHRE’s online magazine reviewed a presentation outlining the latest ESHRE guidelines and recommendations for the use of Time-Lapse Technology within the IVF laboratory.

Joyce Leyden

Joyce’s online article can be found at:

https://www.focusonreproduction.eu/article/ESHRE-News-Annual-Meeting-2020-Montjean

Professor Mary Wingfield (Clinic Director) and Joyce Leyden (Senior Embryologist) have been elected to ESHRE’s Committee of National Representatives for Ireland as Clinician and Basic Scientist, respectively. These positions will be held until 2023 and involve the collation of data of behalf of Ireland and communication with ESHRE as Ireland’s liaison officers.

Merrion Fertility Clinic is very proud of our continued commitment to research within the field of IVF and delighted that work from our Clinic Fellows was presented on the international stage at ESHRE. Well done to all involved, including our collaborators UCD Research Department, National Maternity Hospital and Children’s Hospital Ireland at Crumlin.

The Basics of Conception

In this excerpt from her book, MFC Clinical Director, Prof Mary Wingfield, explains the basic biology behind conception and how this culminates in the miracle of new life:

“The way a human pregnancy and child can develop following a single act of sex between a man and a woman is indeed a miracle of nature and something that, even after all these years, still leaves me in awe. So many minute steps have to happen in a highly co-ordinated and precise pattern – all at a microscopic level. When we realise how intricate it all is, it is not surprising that things can go wrong.

In order to conceive a baby a sperm (male reproductive cell) must fertilise an egg (female reproductive cell). This fertilized egg then develops into an embryo, which implants in the woman’s womb (uterus) and subsequently develops into a foetus and eventually a baby. A woman produces one or two eggs in one or other of her ovaries every month and this is called ovulation. The egg is released from her ovary at the time of ovulation and, by some miracle, the woman’s Fallopian tube, which lies close to the ovary and connects with the uterus, is able to pick up this egg. If the woman has sex around the time of ovulation, some of the sperm that is deposited in her vagina swim through her cervix and uterus up to her Fallopian tube. The hope is that one egg and one sperm will meet in the Fallopian tube. The sperm will penetrate the egg and hopefully fertilise it.

The process of fertilisation takes about 24 hours and then the fertilized egg, which is one cell, divides into two cells, which subsequently divide into four cells and then eight cells and so on. Once the fertilised egg has started dividing into numerous cells we have what is called an embryo. After 2–3 days in the Fallopian tube, the embryo begins to move down towards the uterus or womb. If the lining of the womb is appropriate, which it should be at this time of the woman’s menstrual cycle, the embryo will start to implant in the woman’s uterus – this is approximately five days following ovulation and the embryo at this stage is called a blastocyst. As implantation progresses, the placenta part of the embryo starts producing a hormone called hCG (human chorionic gonadotropin), which supports the pregnancy. This hormone, which is excreted into the woman’s blood and urine, forms the basis of a pregnancy test and will give a positive pregnancy test 10 to 16 days after ovulation.

In order for all of the above to happen, it is really important that the couple have had sex in the days leading up to and around the time the woman is ovulating as that is the only time when there will be an egg available for the sperm to fertilise.

If a couple have an active sex life and are having sex every two or three days, they don’t need to concern themselves with the ‘fertile time’ – they will be having sex often enough.

Eggs are also called ova or oocytes. They are stored in the ovaries, in small sacs called follicles. These follicles can be seen on an ultrasound scan. Women are born with all their eggs in their ovaries. At birth, the ovaries contain one to two million eggs and these are arrested at an early stage of development. After puberty, several eggs begin to mature each month but only one or two are ovulated and the final stage of development of the egg does not happen until the egg is fertilised by a sperm.

The egg is one of the largest cells in the human body, and can even be just about visible to the naked eye. Like sperm, eggs contain half the normal number of chromosomes (23) in their nuclei and these combine with the 23 male chromosomes at fertilisation to produce one fertilised egg with a full complement of chromosomes (46). The egg also contains other structures, such as mitochondria, which are essential for normal development of the early embryo (mitochondria produce energy for the cell). Indeed, the first three days or so of an embryo’s life is controlled and determined by the egg, rather than by the sperm.”

‘The Fertility Handbook’ is available to purchase – click here – with profits going to Merrion Fertility Foundation.

Please click here if you are concerned about your fertility and would like to make an appointment to see one of the MFC team of doctors.

Optimise Male Fertility

This week is Men’s Health Awareness week. To help raise awareness, Merrion Fertility Clinic have put together this short guide on the most important lifestyle changes you can make to optimise male fertility:

Stop smoking: It is well established that smoking affects fertility in both women and men. Cigarette smoking is associated with reduced sperm counts, reduced sperm motility and reduced numbers of normally shaped sperm (sperm morphology), as well as genetic DNA damage in sperm. Smoking by men also reduces the success rates of IVF by at least 40%. Thankfully, quitting smoking can reverse some of the detrimental effects on male fertility.

Avoid steroids and performance enhancers: An ever-increasing problem that we are seeing in our clinics is the impact of certain male supplements on reproductive function. Use of anabolic steroids has increased tenfold in Ireland since 2015. Many men are also taking testosterone supplements or supplements available online which they think are innocuous. However, many of these supplements contain lots of additives, including testosterone. These drugs have a devastating effect on male fertility and testicular function. Sperm production is dependent on normal testosterone levels in the testis, but if the man is flooded with excess testosterone, his natural testosterone production is switched off, with drastic effects on reproduction. This leads to complete absence of sperm (azoospermia) or very reduced sperm counts and reduced size and health of the testis. The good news is that four to six months after discontinuing these drugs, sperm counts and quality generally return to normal levels.

Exercise in moderation: While the relationship of exercise and fertility in men hasn’t been studied as much as in women, the beneficial effects of exercise on general health, bones and mental health are similar. Lots of studies show that excessive exercise can affect sperm counts but it has not been proven whether or not this actually affects fertility. If a man has a very good sperm count and quality to start off with, this probably doesn’t make a huge difference, but if his sperm count is borderline, something like running a marathon may just tip him over. Moderation is the key – a regular amount of moderate exercise is ideal, but try to avoid putting your body under excessive stress. On the other end of the spectrum, obesity in men (which usually goes along with not doing enough exercise) is also bad for sperm and fertility. Excessive heat is not good for sperm so it’s best to avoid hot yoga, saunas or jacuzzis.

Get to a healthy weight: Diet and weight are huge problems in modern western society and Ireland is no exception. Overweight and obese men have increased fertility issues like reduced semen quality (reduced sperm count, concentration and motility), impaired erectile function, and other physical problems, including sleep apnoea and increased scrotal temperatures. Obese men have been shown to have decreased levels of testosterone and other hormones, possibly related to increased oestrogen production in fat tissue. Male obesity may also affect the health of future generations. Studies have shown that obese fathers have a higher likelihood of fathering obese children, irrespective of maternal obesity, and studies in animals show that poor sperm development in obese animals are transmitted to the embryo and may lead to health issues in their offspring. Making fundamental changes to your diet by incorporating wholegrains, lots of vegetables, moderate amounts of fruit and protein and reducing your intake of refined and processed sugars can help support a healthy weight loss and a healthier lifestyle for you and your future children.

Remember the ‘3 month rule’: the entire process of producing a sperm that is capable of fertilizing an egg takes about 90 days, or around three months. Any intervention or lifestyle change you make to improve sperm (e.g. stopping smoking) takes at least three months to have an effect.

The information above is based on the ‘The Fertility Handbook’ by Prof Mary Wingfield, MFC Clinical Director – click here for more information on the book.

If you have concerns about your fertility and would like to speak with one of our team of doctors, please contact us at 01 663 5000 or email us at info@merrionfertility.ie

 

Supporting Dublin Pride Month

Situated at the heart of Dublin’s Pride parade, Merrion Fertility Clinic is proud to offer fertility services to the LGBTQ+ community. Our donor sperm programme commenced in 2017 and we are delighted to see the service grow over the past 3 years.

If you are thinking of starting a family and would like some advice, please contact us on 01-6635000. Our services include donor sperm intrauterine insemination (IUI) and in-vitro fertilisation (IVF). We also offer egg and sperm freezing for transgender men and women who wish to consider fertility preservation prior to transitioning. In addition, we have in-house counselling to help you with your fertility journey – visit www.merrionfertility.ie. For other support networks, visit http://nisig.com/

Our dedicated donor sperm co-ordinators assist patients in selecting and purchasing their donor. We are licensed to import donor sperm from two of the world’s most reputable sperm banks; Cryos International and European Sperm Bank. Both Danish based banks offer a wide variety of eligible donors ranging in; ethnicity, physical characteristics, and educational achievements. Some donor profiles even offer baby photos of the donor, interview questions of his life experiences, motivations, interests and hobbies.

The recent introduction of the Children and Family and Relationships Act (2015) has legislated for only identifiable (non-anonymous) donors to be used in Ireland. The Act also introduced a ‘National Conceived Person Register’, meaning that any child born from donor treatment, once they turn 18, can trace their donor. Any donor treatment in Ireland now requires special consents, which have been designed by the Irish Department of Health, to be signed before treatment by patients, their partners where applicable and the donor. For more information about the CFRA and its implications, visit www.lgbt.ie or contact Merrion Fertility Clinic – info@merrionfertility.ie

Disappointingly, this years Dublin Pride Festival has been cancelled due to Covid19. However, the organisers have transformed many events into a Digital Pride, taking place June 18-28th, with a fantastic programme and an interactive Virtual Parade and Concert on Sunday June 28th. See www.dublinpride.ie/events for the full schedule.

We at MFC would like to wish the LGBTQ+ community a very happy pride month and hope you get to enjoy this years Dublin Pride in a safe and virtual way.

Re-starting Treatments at Merrion Fertility Clinic

Re-starting Treatments

In line with the stabilisation of the virus across Europe and the lack of reports of harmful effects in the first trimester such as miscarriage or foetal abnormalities, the IVF community internationally is looking at slowly restarting services. On 23rd and 24th April respectively, ESHRE (European Society for Human Reproduction and Embryology) and ASRM (American Society for Reproductive Medicine) published guidance for clinics regarding slowly recommencing treatments.

Both acknowledged that Infertility is a disease that is time sensitive and, therefore, should be regarded as a necessary medical treatment. They advocated that, once the risk of COVID-19 infection was decreasing, Assisted Reproductive Technology (ART) treatments be restarted, in line with local regulations.

However, this is not ART treatment as we did in the past; rather, vigilance and measured steps must be taken to protect patients, staff and the wider community. These steps will require significant alterations to the way clinics operate and the recommencement of services will need to be done in a careful, measured manner.

At Merrion Fertility Clinic

We are watching all of these events extremely closely and it is our hope that we will be able to open our clinic to some patients in mid-May. This will depend on the situation in Ireland at that time but we are optimistic.

We are currently working on our procedures and practices to ensure that we can provide a safe service in a responsible but patient-friendly manner. Changes will include:

Triaging patients and staff

  • Monitoring staff and patients for any signs of infection
  • Screening questionnaires
  • Temperature checks
  • COVID-19 screening when available

Hygiene practices

  • Cleaning regimes
  • Hand sanitisers

Social distancing through

  • Reduced clinic visits
  • Staggered appointments
  • Restricting partners
  • Increased use of tele-health
  • Reduced numbers of staff in clinic

Use of PPE

  • Masks, gloves, aprons, gowns

These remain very uncertain times and, when we do open, the new required practices, combined with the need to accommodate patients who have had their treatment cancelled in March and April, will mean that some of our patients will continue to experience frustration and disappointment for a while but please rest assured, we are doing everything possible to minimise this.

Background – Why Treatments Were Stopped

As you all know, COVID-19 has taken the world by storm and left even very developed economies struggling. Back in early to mid-March, the virus was out of control in Italy and Spain and Ireland was facing a potential similar surge in cases and in deaths. There were very legitimate concerns about the ability of our health system to cope.

Very little was known about the virus in general and even less was known about its effect on pregnancy and particularly early pregnancy.   For this reason, international medical and scientific communities dealing with infertility such as ESHRE, ASRM and the British Fertility Society cautioned against fertility treatments at this time and recommended that clinics stop any treatments that could lead to pregnancy.   At the same time Ireland, like other countries, introduced very strict social distancing and lockdown measures.

In mid March 2020, therefore, all fertility clinics in Ireland decided to postpone fertility treatments.   This was never done lightly and we were always conscious of the huge distress it would cause our patients, particularly those who do not have time on their side. However, it was genuinely done in what at that time was very much the best interest of patients, our staff and our nation.

Thankfully, the future is looking much brighter than it did a month ago. The effect of the virus in Ireland has been tragic but it has not been as devastating as in other countries and the lockdown measures definitely seem to be working. We are all hoping that these restrictions will be eased somewhat in early May.

In addition, the evidence regarding pregnant women is reassuring.

Effect of the Virus on Pregnancy/Pregnant Women

As a group, pregnant women seem to be no more at risk of contracting the virus than non-pregnant women. The virus does not seem to be transmitted from mother to baby in the bloodstream, amniotic fluid or breast milk and there has been no evidence of any increase in fetal abnormalities. There may be a slight increase in premature deliveries but this is not certain.

However, the evidence to date is still predominantly for women diagnosed with the virus in late pregnancy. The most recent study of 116 cases from China only included 8 women in early or mid-pregnancy.

We also know that any severe infection or illness can have an adverse impact on pregnancy and COVID-19 is no exception. Pregnancy of itself produces changes in the woman’s cardiovascular, respiratory and blood clotting systems, which make ventilation and ICU care for any condition difficult. The majority of women who developed severe symptoms of COVID-19 worldwide were delivered early by Caesarean section, many of those prematurely.

With this in mind, over the coming weeks MFC will be:

  • ensuring that no high-risk patients begin treatment until it is deemed safe to by the relevant healthcare bodies
  • offering patients the option to postpone treatment should they wish to
  • providing advice and education on COVID-19 risk and prevention
  • having all patients sign a Code of Conduct which gives instruction on best practices during treatment
  • having patients fill out a COVID-19 triage questionnaire before and during treatment
  • following up with patients in the weeks after egg collection and embryo transfer to identify potential COVID-19 positive patients and implement necessary measures

Contacting Patients

We will be contacting people very soon to arrange appointments and start some treatments. In the meantime, our staff are available to answer queries and to provide support by phone or email (Ph. 01 663 5000 or info@merrionfertility.ie)

The situation is a lot brighter than it was six weeks ago and we look forward to seeing all of our patients again soon.

 

ESHRE Announcement on Recommencing ART Treatments

We are delighted to see that ESHRE has today released guidance on restarting ART treatments. This is great news for our patients but the safety requirements are stringent and require careful planning over the next few weeks. We are looking forward to seeing our patients again soon.

When you click on the link below to the ESHRE website, in the top left-hand corner, there is a downloadable document called ‘ESHRE Guidance on Recommencing ART Treatments’, which contains more detailed information and we highly recommend you review it.
www.eshre.eu/COVID19WG

ART In Europe

ART In Europe

We know that the cancellation and postponement of treatment due to Covid 19 has brought untold stress and disappointment for our patients and for those all across Europe – see map released by ESHRE on 20/04/20.

But there are signs that activity is resuming as Denmark, Germany and the Netherlands slowly recommence services. We in MFC hope to also commence treatments in May, if the current trends in suppression of the virus continue and if national restrictions begin to ease. This will have to begin slowly and under strict guidelines and we will update our website as things progress.

In the meantime, don’t lose hope, try to optimise your health and wellbeing and don’t hesitate to contact our team of caring professionals if you have any queries or concerns.

http://www.eshre.eu/COVID19WG

 

 

Coping During the COVID-19 Pandemic: Message for Our Patients

The Covid-19 pandemic has changed life as we know it. For those patients struggling with infertility, particularly those awaiting treatment, anxiety and distress are both common and understandable responses to an unprecedented situation. At Merrion Fertility Clinic, we are here to support and guide you through this uncertain time.

Merrion Fertility have a number of support systems in place, including:

  • Support group meeting next Wednesday, 15th April by phone/video link
  • Patient consultations via phone or video link
  • Clinic is currently fully staffed and available to answer any questions (though most of us are working remotely)
  • Kay Duff, our fertility counsellor, can be contacted through the clinic or confidentially on +353 (1) 8319625 or  at catherineduff76@gmail.com.

For additional practical information on coping with stress and anxiety, please see the following excellent article recently published by the Mental Health Professional Group.

https://www.asrm.org/news-and-publications/news-and-research/announcements/coping-during-the-covid-19-pandemic–messages-for-patients/

Now more than ever it is important to take good care of yourself, and to remember that we are all in this together.

Stay safe and well.

 

Is it safe to get pregnant during the Covid-19 Pandemic?

Covid-19

These are very uncertain times. The medical profession, scientists, politicians and the general public are grappling with how best to manage a new virus and a pandemic like none we have seen before.

Medical and scientific evidence about the virus is accumulating daily, but there is still a lot we don’t know.

The evidence to date on pregnant women who have contracted Covid-19 and delivered babies is very reassuring. International bodies including the Royal College of Obstetricians and Gynaecologists in London are at pains to reassure pregnant women that they do not need to panic but, like the rest of us, they need to take extra precautions, particularly around social distancing and hygiene.

To date we know of nine women in the Chinese city of Wuhan who were diagnosed with Covd-19 in late pregnancy (36-39 weeks). None of these women developed severe respiratory disease; their clinical course was similar to that of non-pregnant women with the disease. All their babies were delivered by Caesarean section; all the babies were well and no virus was found in the amniotic fluid, the infants or breast milk.

Since then, 13 other pregnancies have been reported in Chinese women outside Wuhan. One became critically ill but this incidence is no higher than in the non-pregnant population. Six of these women went into premature labour and there was one stillbirth but we cannot say if these complications were related to the virus. In other reports, two babies have been diagnosed with infection soon after birth, one in the US and one in London, but it seems likely the infection happened after the birth rather than during the pregnancy or birth. This is all very reassuring for pregnant women.

Trying to conceive

But what about those who are not pregnant but are thinking about it or are trying to conceive? Should they be getting pregnant at this moment in time? It is really difficult to give clear advice in this regard, because we just don’t have enough evidence or experience with this virus. The reassuring studies described above involve very small numbers of women and all were in the later stages of pregnancy. There have been no reports yet on the outcomes of women infected in early pregnancy. We don’t know how the virus behaves in early pregnancy.

Because of this uncertainty, three international fertility bodies – the European Society for Human Reproduction and Embryology, the American Society for Reproductive Medicine and the British Fertility Society have in the last few days given guidance to fertility specialists advising them not to provide any treatment which would lead to pregnancy.

Irish fertility clinics – and many others in the US and Europe – have stopped doing treatments that would result in a pregnancy at this time. This includes IVF cycles, intrauterine or artificial insemination (IUI) and the use of fertility drugs to induce ovulation.

For people midway through IVF treatment, it is advised to freeze embryos for future use rather than to transfer them now. It is important to stress that these are very much precautionary measures until we have more data regarding the effects of Covid-19 in early pregnancy. It is undoubtedly extremely stressful for patients, but most agree it is best to be cautious at this time.

Other factors that affect this decision are the need to observe social distancing to reduce spread of the disease and help to “flatten the curve”. We can do this only by minimising the number of people attending clinics. However, many clinics are still open and staffed by nurses, doctors and other support staff who can answer queries and help people through this difficult time.

Concieve naturally

The halting of fertility treatment by clinics raises the question as to whether people who do not have fertility problems should continue to conceive naturally or spontaneously. The short answer is that we just don’t know. There really is no guidance available yet about this.

We know that those with underlying health problems – people who are immune-suppressed or who have diabetes or chronic lung disease – are more at risk of serious illness if infected with the virus. It would seem prudent that this group consider avoiding pregnancy at this time.

Young women who are fit and healthy and have no fertility-related issues may wish to postpone pregnancy for a few months until we have more information. Older women and those with known fertility issues often do not have time on their side, so they may wish to continue trying to conceive – or they may wish to wait a little while too.

Duty of care

Because fertility treatment such as IVF is an elective medical treatment, those working in fertility clinics have a medical duty of care to their patients not to provide a treatment unless there is sufficient evidence that it is safe. However, individuals trying naturally will have to make their own decisions at this time of such uncertainty.

There are conflicting opinions among doctors and scientists as to whether we should reassure or worry the general public at this time. There is a fine balance to be struck.

The aim of this article is to share the current evidence – scanty as it is – in the public domain so that the general public are aware of the pros and cons of conceiving at the present time. The evidence and guidance will be updated over the coming weeks as more pregnancy outcomes are reported. In the meantime, some advice would be to not panic, stay on folic acid and any other recommended medications and use this time to optimise one’s physical and mental health.

Professor Mary Wingfield is clinical director at the Merrion Fertility Clinic and a consultant obstetrician gynaecologist at the National Maternity Hospital