Patient Resources

• 1: Fertility Services
• 2: Insurance
• 3: Early Pregnancy Services
• 4: Antenatal Services
• 5: High-Risk Pregnancy Care
• 6: Birth & Delivery Services
• 7: Pregnancy Scans
• 8: Genetic Testing Services
• 9: Fertility Preservation & Freezing Services
• 10: Endometriosis Services
• 11: Benign Gynaecology Services
• 12: Contraception Services
• 13: Laparoscopic Surgery
• 14: Hysteroscopy

1 - Fertility Services

Our Fertility Services offer comprehensive diagnosis and treatment for couples and individuals struggling to conceive. With advanced reproductive technologies and personalised care, we help you achieve your dream of starting or growing your family.

Our Fertility Services

• Initial fertility assessment
• Ovulation induction
• Intrauterine insemination (IUI)
• In vitro fertilisation (IVF)
• Intracytoplasmic sperm injection (ICSI)
• Frozen embryo transfer (FET)
• Blastocyst culture and transfer
• Assisted hatching
• Male fertility treatments
• Fertility preservation

When to Seek Fertility Help

Consider a fertility consultation if:

• You’ve been trying to conceive for 12 months without success (if under 35)
• You’ve been trying for 6 months without success (if 35 or over)
• You have irregular or absent periods
• You have a known fertility condition (endometriosis, PCOS)
• You have a history of recurrent miscarriage
• You or your partner have a known medical condition affecting fertility
• You’re planning pregnancy after cancer treatment
• You want to preserve your fertility for the future

Initial Fertility Assessment

For Women

Medical history:

• Menstrual cycle regularity
• Previous pregnancies
• Medical conditions
• Surgical history
• Medications

Investigations:

• Hormone blood tests (FSH, LH, AMH, oestradiol, prolactin, thyroid)
• Pelvic ultrasound (antral follicle count, uterine assessment)
• Tubal patency test (HyCoSy or HSG)
• Hysteroscopy if indicated

For Men

Medical history:

• Previous pregnancies fathered
• Medical conditions
• Medications
• Lifestyle factors

Investigations:

• Semen analysis (sperm count, motility, morphology)
• Hormone tests if indicated
• Ultrasound if indicated
• Genetic testing if indicated

Ovulation Induction

What Is It?

Ovulation induction uses medication to stimulate the ovaries to produce eggs in women who don’t ovulate regularly or at all.

Who Is It For?

• Women with irregular or absent periods
• Women with polycystic ovary syndrome (PCOS)
• Women with unexplained infertility (with timed intercourse)

Medications Used

Clomiphene citrate (Clomid):

• Oral medication taken for 5 days early in the cycle
• Stimulates the pituitary gland to release FSH
• First-line treatment for anovulation

Letrozole:

• Oral medication, alternative to clomiphene
• Often used for PCOS
• May have better outcomes for some women

Gonadotropins (FSH injections):

• Injectable hormones
• Used when oral medications don’t work
• More powerful stimulation
• Requires careful monitoring

Monitoring

• Ultrasound scans to track follicle development
• Blood tests to monitor hormone levels
• Timing of intercourse or insemination

Risks

• Multiple pregnancy (twins or more)
• Ovarian hyperstimulation syndrome (OHSS)

IUI (Intrauterine Insemination)

What Is IUI?

IUI is a fertility treatment where prepared sperm is placed directly into the uterus around the time of ovulation, giving sperm a better chance of reaching the egg.

Who Is IUI Suitable For?

• Unexplained infertility
• Mild male factor infertility
• Cervical factor infertility
• Ovulation disorders (combined with ovulation induction)
• Ejaculation difficulties

The IUI Process

1. Ovarian stimulation (if needed)

• Medications to stimulate egg development
• Monitoring with ultrasound and blood tests

2. Trigger injection

• hCG injection to trigger ovulation
• Timing is carefully planned

3. Sperm preparation

• Semen sample collected
• Sperm washed and concentrated
• Best quality sperm selected

4. Insemination

• Prepared sperm inserted through the cervix into the uterus
• Quick procedure (5-10 minutes)
• Similar to a smear test
• Usually painless

5. Pregnancy test

• Approximately 2 weeks after insemination

Success Rates

• 10-20% per cycle (varies by age and diagnosis)
• Usually recommended for 3-6 cycles before considering IVF
• Cumulative success rates improve with multiple cycles

Advantages

• Less invasive than IVF
• Lower cost than IVF
• Minimal medication (can be done in natural cycle)
• No egg collection procedure required

IVF (In Vitro Fertilisation)

What Is IVF?

IVF is an assisted reproductive technology where eggs are collected from the ovaries and fertilised with sperm in a laboratory. The resulting embryos are then transferred to the uterus.

Who Is IVF Suitable For?

• Blocked or damaged fallopian tubes
• Severe male factor infertility
• Endometriosis
• Unexplained infertility (after failed IUI)
• Advanced maternal age
• Genetic testing requirements (PGT)
• Previous failed fertility treatments
• Using frozen eggs or embryos

The IVF Process

1. Ovarian stimulation (8-14 days)

• Daily hormone injections to stimulate multiple eggs
• Regular monitoring with ultrasound and blood tests
• Dose adjustments as needed

2. Trigger injection

• hCG or GnRH agonist injection
• Given when follicles are mature
• Egg collection scheduled 34-36 hours later

3. Egg collection (egg retrieval)

• Minor procedure under sedation
• Ultrasound-guided needle aspiration
• Takes 15-30 minutes
• Recovery for 1-2 hours

4. Fertilisation

• Eggs and sperm combined in the laboratory
• Conventional IVF or ICSI
• Fertilisation checked the next day

5. Embryo culture

• Embryos monitored for 3-6 days
• Development assessed daily
• Best embryos selected for transfer

6. Embryo transfer

• Simple procedure (no anaesthesia needed)
• Embryo(s) placed in the uterus using a thin catheter
• Takes 5-10 minutes
• Rest briefly, then go home

7. Luteal phase support

• Progesterone supplementation
• Supports the uterine lining
• Continues until pregnancy test (and beyond if positive)

8. Pregnancy test

• Blood test approximately 11-14 days after transfer

IVF Protocols

We offer various stimulation protocols tailored to your individual needs:

Long Agonist Protocol

How it works:

• GnRH agonist (e.g., Buserelin, Lupron) started in the luteal phase (day 21) of the previous cycle
• Agonist “downregulates” the pituitary gland, preventing premature ovulation
• Stimulation with gonadotropins begins once downregulation is confirmed
• Continues until trigger injection

Best suited for:

• Normal ovarian responders
• Women with regular cycles
• When precise control of ovulation timing is needed

Advantages:

• Well-established protocol with predictable response
• Good synchronisation of follicle development
• Flexible scheduling

Duration: Approximately 4-5 weeks

Short Agonist Protocol (Flare Protocol)

How it works:

• GnRH agonist started on day 1-2 of the cycle
• Initial “flare” effect stimulates natural FSH release
• Gonadotropins added shortly after
• Uses the body’s natural hormone surge

Best suited for:

• Poor ovarian responders
• Women with low ovarian reserve
• Older women

Advantages:

• Shorter treatment duration
• May improve response in poor responders
• Uses natural FSH boost

Antagonist Protocol

How it works:

• Stimulation with gonadotropins starts on day 2-3 of the cycle
• GnRH antagonist (e.g., Cetrotide, Ganirelix) added when follicles reach 12-14mm
• Antagonist prevents premature LH surge and ovulation
• Continues until trigger injection

Best suited for:

• High responders (PCOS)
• Women at risk of OHSS
• Poor responders
• Most patients in modern IVF

Advantages:

• Shorter treatment time (10-14 days)
• Lower risk of ovarian hyperstimulation syndrome (OHSS)
• More patient-friendly (fewer injections initially)
• Can use GnRH agonist trigger (further reduces OHSS risk)

Duration: Approximately 2-3 weeks

Natural Cycle IVF

How it works:

• No stimulation medications
• Single egg develops naturally
• Careful monitoring to catch ovulation

Best suited for:

• Women who cannot use hormonal stimulation
• Those who prefer a natural approach
• Repeated poor response to stimulation

Considerations:

• Lower success rates per cycle
• Risk of cycle cancellation if egg is lost
• May need multiple cycles

Mild Stimulation IVF

How it works:

• Lower doses of gonadotropins
• May combine with oral medications (Clomid/Letrozole)
• Aims for 3-6 eggs

Best suited for:

• Women concerned about OHSS
• Those preferring a gentler approach
• Cost-conscious patients

Advantages:

• Fewer eggs but potentially better quality
• Reduced side effects
• Lower medication costs

Time-Lapse Embryo Monitoring

What Is Time-Lapse?

Time-lapse technology uses a specialised incubator with a built-in camera that takes images of embryos every 10-20 minutes throughout their development. This creates a continuous video of embryo development without disturbing the culture environment.

How Does It Work?

• Embryos remain in a stable, undisturbed environment
• Camera captures thousands of images over 5-6 days
• Software analyses development patterns
• Embryologists review detailed developmental history

Benefits of Time-Lapse

Improved embryo selection:

• Identifies embryos with the best developmental potential
• Detects abnormal development patterns not visible in standard assessment
• Provides additional selection criteria beyond appearance

Undisturbed culture:

• Embryos stay in optimal conditions continuously
• No need to remove embryos from incubator for daily checks
• Stable temperature, humidity, and gas levels

Detailed information:

• Complete developmental timeline
• Timing of cell divisions
• Detection of abnormalities (multinucleation, reverse cleavage)
• Better prediction of blastocyst development

Documentation:

• Video record of your embryos’ development
• Can be shared with you to show your embryos growing

Who Benefits Most?

• Patients with multiple good-quality embryos (helps select the best)
• Previous failed cycles (may identify embryo quality issues)
• Patients undergoing single embryo transfer
• Those wanting additional reassurance about embryo selection

ICSI (Intracytoplasmic Sperm Injection)

What Is ICSI?

ICSI is a specialised form of IVF where a single sperm is injected directly into each egg to achieve fertilisation. It’s used when standard IVF fertilisation may not be successful.

When Is ICSI Recommended?

Male factor infertility:

• Very low sperm count
• Poor sperm motility
• Abnormal sperm morphology
• Sperm retrieved surgically (PESA, TESA, micro-TESE)
• High sperm DNA fragmentation

Other indications:

• Previous failed fertilisation with standard IVF
• Low number of eggs collected
• Using frozen sperm
• Using frozen eggs
• Preimplantation genetic testing (PGT)

The ICSI Process

1. Eggs collected as in standard IVF
2. Mature eggs identified
3. Single sperm selected for each egg
4. Sperm injected directly into the egg
5. Fertilisation checked the next day
6. Embryo culture and transfer as standard IVF

Success Rates

• ICSI fertilisation rates: 70-80%
• Pregnancy rates similar to conventional IVF
• Particularly beneficial for severe male factor

Blastocyst Culture and Transfer

What Is Blastocyst Transfer?

Blastocyst transfer involves growing embryos in the laboratory until day 5-6 (blastocyst stage) before transfer, rather than transferring on day 2-3.

Advantages

• Better embryo selection (strongest embryos reach blastocyst)
• Higher implantation rate per embryo
• Allows single embryo transfer (reduces multiple pregnancy risk)
• Better synchronisation with the uterus
• Allows time for genetic testing (PGT)

Considerations

• Not all embryos reach blastocyst stage
• Risk of no embryos for transfer (if all arrest)
• May not be recommended if few embryos available

Frozen Embryo Transfer (FET)

What Is FET?

FET uses embryos that were frozen from a previous IVF cycle and thawed for transfer in a subsequent cycle.

When Is FET Used?

• Excess embryos from fresh IVF cycle
• All embryos frozen (freeze-all strategy)
• After preimplantation genetic testing
• After failed fresh transfer
• For fertility preservation

FET Protocols

Natural cycle FET:

• Transfer timed with natural ovulation
• No or minimal medications
• Suitable for women with regular cycles

Hormone replacement (HRT) cycle:

• Oestrogen and progesterone given to prepare the lining
• More control over timing
• Suitable for irregular cycles

Stimulated cycle:

• Mild ovarian stimulation
• Transfer timed with ovulation

Success Rates

• FET success rates are now comparable to or better than fresh transfers
• Vitrification technology has significantly improved embryo survival (>95%)

Surgical Sperm Retrieval

For men with no sperm in the ejaculate (azoospermia), sperm can be retrieved surgically:

PESA (Percutaneous Epididymal Sperm Aspiration)

• Needle aspiration from the epididymis
• Used for obstructive azoospermia
• Local anaesthesia
• Quick procedure

TESA (Testicular Sperm Aspiration)

• Needle aspiration from the testicle
• Used when PESA unsuccessful
• Local anaesthesia

Micro-TESE (Microscopic Testicular Sperm Extraction)

• Surgical retrieval under microscope
• Used for non-obstructive azoospermia
• Best chance of finding sperm in difficult cases
• General anaesthesia required

Assisted Hatching

What Is It?

Assisted hatching is a laboratory technique where a small opening is made in the outer shell (zona pellucida) of the embryo to help it “hatch” and implant.

When Is It Used?

• Older women (over 38)
• Thickened zona pellucida
• Previous failed implantation
• Frozen embryos

Success Rates

Success rates depend on many factors:

Factors Affecting Success

Female age:

• Under 35: Highest success rates
• 35-37: Good success rates
• 38-40: Declining success rates
• Over 40: Significantly reduced success rates
• Over 43: Very low success rates with own eggs

Other factors:

• Cause of infertility
• Ovarian reserve (AMH, AFC)
• Sperm quality
• Number and quality of embryos
• Uterine factors
• Lifestyle factors
• Previous treatment history

Our Approach to Success

• Individualised treatment protocols
• Advanced laboratory techniques
• Experienced embryology team
• Comprehensive support throughout treatment
• Continuous improvement and monitoring of outcomes

Emotional Support

We understand that fertility treatment can be emotionally challenging:

• Counselling services available
• Support at every stage of treatment
• Clear communication about progress
• Realistic expectations discussed
• Resources and support groups

Your Fertility Journey With Us

Step 1: Initial Consultation

• Review of medical history
• Discussion of concerns and goals
• Initial investigations arranged

Step 2: Diagnosis

• Results reviewed
• Diagnosis explained
• Treatment options discussed

Step 3: Treatment Planning

• Personalised treatment plan created
• Timeline and process explained
• Consent and preparation

Step 4: Treatment

• Close monitoring throughout
• Accessible support team
• Adjustments as needed

Step 5: Outcome

• Pregnancy test and follow-up
• Early pregnancy monitoring if successful
• Review and next steps if unsuccessful

Frequently Asked Questions

How long does IVF take? One IVF cycle takes approximately 4-6 weeks from the start of medication to pregnancy test.

Is IVF painful? Injections may cause mild discomfort. Egg collection is done under sedation and is not painful. Embryo transfer is usually painless.

How many embryos should be transferred? We recommend single embryo transfer in most cases to reduce the risk of multiple pregnancy. This is discussed individually based on age, embryo quality, and history.

What are the risks of IVF? Main risks include ovarian hyperstimulation syndrome (OHSS), multiple pregnancy, and emotional stress. These are carefully managed with monitoring and protocols.

Can I work during IVF? Most women can continue working during IVF. You may need time off for monitoring appointments and 1-2 days rest after egg collection.

What if IVF doesn’t work? We review each cycle to understand what happened and discuss options for next steps, which may include another cycle with protocol adjustments, different approaches, or alternative family building options.

Book a Consultation

If you’re ready to explore your fertility options or have been trying to conceive without success, our team is here to help. Contact us at info@salamivf.com or call +973 1725 5095 to schedule your fertility consultation.

2 - Insurance

We work with a wide range of insurance providers to make your healthcare experience as smooth as possible. Below you’ll find information about accepted insurance plans and coverage details.

Accepted Insurance Providers

• MetLife
• MedNet

Please contact us to confirm your specific plan’s coverage.

What’s Covered?

Coverage varies depending on your insurance plan. Common covered services include:

• Initial consultations
• Diagnostic tests and laboratory work
• Ultrasound and imaging
• Certain fertility treatments (plan-dependent)

How to Use Your Insurance

1. Before your visit — Contact your insurance provider to confirm coverage for fertility services
2. At registration — Bring your insurance card and a valid ID
3. Pre-authorization — Some procedures may require pre-authorization from your insurer. Our staff can help you with this process
4. Co-payments — Any applicable co-payments or deductibles will be collected at the time of service

Self-Pay Options

For patients without insurance or for services not covered by insurance, we offer competitive self-pay rates. Please contact our reception for a detailed price list.

Questions?

Our team is happy to help you understand your coverage. Contact us at info@salamivf.com or call +973 1725 5095.

3 - Early Pregnancy Services

Our Early Pregnancy Services provide dedicated care and support during the crucial first weeks of your pregnancy. Whether you’ve conceived naturally or through fertility treatment, our team is here to monitor your progress and ensure a healthy start for you and your baby.

What Are Early Pregnancy Services?

Early pregnancy services focus on the care and monitoring of pregnancies during the first trimester (weeks 1-12). This is a critical period when the foundation for your baby’s development is established, and when many women benefit from close medical supervision and reassurance.

Who Should Use Early Pregnancy Services?

Our early pregnancy services are available to all pregnant women, but are particularly recommended for:

• Women who have conceived through IVF, ICSI, or other fertility treatments
• Women with a history of miscarriage or recurrent pregnancy loss
• Women with previous ectopic pregnancy
• Women with a history of molar pregnancy
• Women experiencing bleeding or pain in early pregnancy
• Women with severe nausea, vomiting, or hyperemesis gravidarum
• Women with underlying health conditions (diabetes, thyroid disorders, etc.)
• Women over 35 years of age
• Anyone seeking reassurance and early pregnancy monitoring

What’s Included in Our Early Pregnancy Services?

Early Pregnancy Scans

• Viability scan (6-8 weeks) — Confirms pregnancy location, heartbeat, and number of embryos
• Dating scan (8-10 weeks) — Establishes accurate due date and assesses early development
• Nuchal translucency scan (11-14 weeks) — Screens for chromosomal abnormalities

Blood Tests & Monitoring

• Beta-hCG levels to confirm and monitor pregnancy progression
• Progesterone levels when indicated
• Early pregnancy screening blood tests
• Thyroid function tests
• Anaemia and vitamin D screening

Medical Support

• Management of early pregnancy symptoms (nausea, fatigue)
• Assessment and treatment of bleeding or pain
• Progesterone supplementation when needed
• Referral for further investigations if required

Emotional Support

• Reassurance during an anxious time
• Clear communication about your pregnancy progress
• Guidance on what to expect in the coming weeks

What to Expect at Your First Visit

1. Medical history review — We’ll discuss your medical history, previous pregnancies, and any relevant health conditions
2. Ultrasound scan — A transvaginal or abdominal scan to visualise the pregnancy
3. Blood tests — If required, to check hormone levels and overall health
4. Discussion — Your doctor will explain the findings and outline a care plan
5. Next steps — Scheduling of follow-up appointments and ongoing monitoring

When to Seek Early Pregnancy Care

Contact us immediately if you experience:

• Vaginal bleeding or spotting
• Severe abdominal pain or cramping
• Shoulder tip pain
• Dizziness or fainting
• Severe nausea and vomiting preventing eating or drinking

Transitioning to Antenatal Care

Once you complete your first trimester, we’ll ensure a smooth transition to ongoing antenatal care, whether you continue with our team or transfer to your chosen hospital or healthcare provider.

Book an Appointment

If you’ve just discovered you’re pregnant or need early pregnancy support, our team is ready to help. Contact us at info@salamivf.com or call +973 1725 5095 to schedule your appointment.

4 - Antenatal Services

Our Antenatal Services provide comprehensive care and monitoring throughout your pregnancy journey. From the second trimester through to delivery, our experienced team is dedicated to ensuring the health and wellbeing of both you and your baby.

What Are Antenatal Services?

Antenatal care (also called prenatal care) includes all the medical check-ups, tests, and support you receive during pregnancy. Regular antenatal visits allow us to monitor your baby’s growth, identify any potential concerns early, and prepare you for a safe delivery.

Why Is Antenatal Care Important?

Regular antenatal care helps:

• Monitor your baby’s growth and development
• Detect and manage pregnancy complications early
• Screen for genetic conditions and abnormalities
• Manage pre-existing health conditions during pregnancy
• Prepare you physically and emotionally for childbirth
• Reduce the risk of maternal and infant health problems

Our Antenatal Services Include

Regular Check-ups

• Second trimester visits (13-27 weeks) — Monthly appointments to monitor progress
• Third trimester visits (28-40 weeks) — More frequent visits as you approach delivery
• Blood pressure and weight monitoring
• Urine tests to check for infections and protein
• Fundal height measurements to track baby’s growth

Ultrasound Scans

• Anomaly scan (18-22 weeks) — Detailed scan to check baby’s organs and development
• Growth scans (28-36 weeks) — Monitor baby’s size and amniotic fluid levels
• 3D/4D scans — Optional scans to see your baby’s features
• Doppler assessments to check blood flow

Screening & Diagnostic Tests

• Combined first trimester screening (NIPT/Harmony test available)
• Glucose tolerance test (GTT) for gestational diabetes
• Group B Streptococcus (GBS) screening
• Blood tests including full blood count, iron levels, and antibodies
• Amniocentesis or CVS if indicated

High-Risk Pregnancy Care

We provide specialised care for pregnancies with additional risk factors:

• Multiple pregnancies (twins, triplets)
• Maternal age over 35
• Pre-existing conditions (diabetes, hypertension, thyroid disorders)
• Previous pregnancy complications
• Placenta previa or other placental issues
• Gestational diabetes management
• Pre-eclampsia monitoring

Birth Preparation

• Discussion of birth preferences and options
• Information about pain relief choices
• Guidance on signs of labour
• When to go to the hospital
• Postnatal care planning

What to Expect at Your Antenatal Visits

1. Check-in — Weight and blood pressure measurements
2. Urine sample — Tested for protein, glucose, and infections
3. Baby’s heartbeat — Listened to with a Doppler device
4. Fundal height — Measurement of your bump to track growth
5. Discussion — Review any symptoms, concerns, or questions
6. Planning — Schedule next appointment and any required tests

When to Contact Us Between Appointments

Please contact us immediately if you experience:

• Vaginal bleeding at any stage
• Severe or persistent headaches
• Visual disturbances (blurred vision, seeing spots)
• Severe abdominal pain
• Reduced baby movements
• Sudden swelling of face, hands, or feet
• Signs of labour before 37 weeks
• Waters breaking
• Fever or signs of infection

Our Approach to Antenatal Care

At Dr Salam Jibrel Medical Center, we believe in:

• Personalised care — Every pregnancy is unique, and your care plan is tailored to your needs
• Continuity — Building a relationship with your healthcare team throughout pregnancy
• Communication — Keeping you informed and involved in all decisions
• Accessibility — Being available when you need us

Book an Appointment

Whether you’re continuing care from our early pregnancy services or joining us for antenatal care, we’re here to support you. Contact us at info@salamivf.com or call +973 1725 5095 to schedule your appointment.

5 - High-Risk Pregnancy Care

Our High-Risk Pregnancy Services provide specialised care and close monitoring for pregnancies that require extra attention. With experienced specialists and advanced monitoring, we ensure the best possible outcomes for both mother and baby when complications arise or risk factors are present.

What Is a High-Risk Pregnancy?

A high-risk pregnancy is one where the mother, baby, or both have an increased chance of health problems before, during, or after delivery. This may be due to pre-existing medical conditions, complications that develop during pregnancy, or factors related to the pregnancy itself.

Having a high-risk pregnancy doesn’t mean something will go wrong — it means you need closer monitoring and specialised care to ensure the best outcome.

Risk Factors

You may be considered high-risk if you have:

Pre-existing medical conditions:

• Diabetes (Type 1 or Type 2)
• Hypertension (high blood pressure)
• Heart disease
• Kidney disease
• Autoimmune conditions (lupus, thyroid disorders)
• Blood clotting disorders
• Epilepsy
• Mental health conditions

Pregnancy-related factors:

• Multiple pregnancy (twins, triplets)
• Previous pregnancy complications
• Previous caesarean section
• Conceiving through IVF
• Abnormal placenta position
• Cervical insufficiency

Lifestyle and demographic factors:

• Maternal age over 35 (advanced maternal age)
• Maternal age under 18
• Obesity (BMI over 30)
• Underweight (BMI under 18.5)
• Smoking, alcohol, or substance use

Pre-eclampsia

What Is Pre-eclampsia?

Pre-eclampsia is a serious pregnancy condition characterised by high blood pressure and protein in the urine, usually developing after 20 weeks of pregnancy. It affects about 5-8% of pregnancies and can be life-threatening if not managed properly.

Risk Factors for Pre-eclampsia

• First pregnancy
• Previous pre-eclampsia
• Family history of pre-eclampsia
• Multiple pregnancy
• Age over 40 or under 20
• Obesity
• Pre-existing hypertension, diabetes, or kidney disease
• Autoimmune conditions
• More than 10 years since last pregnancy
• IVF pregnancy

Symptoms

Warning signs to watch for:

• Severe headache that doesn’t go away
• Visual disturbances (blurred vision, seeing spots, light sensitivity)
• Severe pain below the ribs (especially on the right)
• Sudden swelling of face, hands, or feet
• Nausea or vomiting (in second half of pregnancy)
• Feeling generally unwell

Note: Pre-eclampsia can develop without obvious symptoms, which is why regular blood pressure checks are essential.

Complications

If untreated, pre-eclampsia can lead to:

• Eclampsia (seizures)
• HELLP syndrome (liver and blood clotting disorder)
• Stroke
• Organ damage (liver, kidney)
• Placental abruption
• Preterm birth
• Fetal growth restriction

Prevention

Low-dose aspirin:

• Recommended for women at high risk
• Started from 12 weeks of pregnancy
• Reduces risk by up to 60%

Calcium supplementation:

• May be recommended if dietary calcium is low

Monitoring

• Regular blood pressure checks
• Urine tests for protein
• Blood tests to check liver and kidney function
• Ultrasound scans to monitor baby’s growth
• Doppler assessment of blood flow

Treatment

• Close monitoring (may require hospitalisation)
• Medication to lower blood pressure
• Magnesium sulphate to prevent seizures
• Corticosteroids if preterm delivery likely
• Delivery — The only cure for pre-eclampsia; timing depends on severity and gestation

Gestational Diabetes

What Is Gestational Diabetes?

Gestational diabetes is high blood sugar that develops during pregnancy and usually resolves after delivery. It occurs when the body cannot produce enough insulin to meet the extra demands of pregnancy.

Risk Factors

• BMI over 30
• Previous gestational diabetes
• Previous large baby (over 4.5 kg)
• Family history of diabetes
• South Asian, Black Caribbean, or Middle Eastern ethnicity
• Previous unexplained stillbirth
• Polycystic ovary syndrome (PCOS)

Screening

Glucose Tolerance Test (GTT):

• Offered at 24-28 weeks of pregnancy
• Earlier testing if high risk
• Fasting blood test, then drink glucose solution, then further blood tests

Why Does It Matter?

Uncontrolled gestational diabetes can cause:

For baby:

• Large baby (macrosomia) — risk of difficult delivery
• Low blood sugar after birth
• Jaundice
• Breathing problems
• Higher risk of obesity and diabetes later in life
• Stillbirth (in severe cases)

For mother:

• Increased risk of pre-eclampsia
• Difficult delivery/caesarean section
• Type 2 diabetes later in life (50% risk within 10 years)

Management

Lifestyle changes (first line):

• Dietary modifications — balanced meals, controlled carbohydrates
• Regular physical activity
• Blood sugar monitoring

Medication (if targets not met):

• Metformin tablets
• Insulin injections

Monitoring:

• Regular blood sugar checks (home monitoring)
• Growth scans to monitor baby’s size
• More frequent antenatal visits

After Delivery

• Blood sugar usually returns to normal
• GTT at 6-12 weeks postpartum to check
• Annual diabetes screening recommended
• Lifestyle advice to reduce future risk

Multiple Pregnancy

Why Is It Higher Risk?

Twin and higher-order multiple pregnancies carry increased risks:

For mother:

• Gestational diabetes
• Pre-eclampsia
• Anaemia
• Caesarean section
• Postpartum haemorrhage

For babies:

• Preterm birth (average 36 weeks for twins)
• Low birth weight
• Twin-to-twin transfusion syndrome (identical twins sharing placenta)
• Growth discordance (one twin smaller than the other)
• Congenital abnormalities

Types of Twin Pregnancy

Monitoring

• More frequent scans (every 2-4 weeks)
• Growth monitoring
• Cervical length assessment
• Screening for twin-to-twin transfusion syndrome
• Earlier delivery planning (usually 36-38 weeks)

Placental Conditions

Placenta Previa

What is it? The placenta is positioned low in the uterus, partially or completely covering the cervix.

Risks:

• Bleeding during pregnancy
• Heavy bleeding during delivery
• Caesarean section usually required

Management:

• Avoid intercourse and strenuous activity
• Hospital admission if bleeding
• Planned caesarean section (usually 36-37 weeks)

Placenta Accreta Spectrum

What is it? The placenta grows too deeply into the uterine wall and may invade surrounding organs.

Risk factors:

• Previous caesarean sections
• Placenta previa
• Previous uterine surgery

Management:

• Specialised surgical planning
• Multidisciplinary team approach
• May require hysterectomy at delivery

Placental Abruption

What is it? The placenta separates from the uterine wall before delivery.

Warning signs:

• Vaginal bleeding
• Severe abdominal pain
• Uterine tenderness
• Contractions

Management:

• Emergency situation requiring immediate medical attention
• May require emergency delivery

Previous Pregnancy Complications

If you experienced complications in a previous pregnancy, you may need closer monitoring:

Previous Pre-eclampsia

• Low-dose aspirin from 12 weeks
• More frequent blood pressure and urine checks
• Growth scans

Previous Preterm Birth

• Cervical length monitoring
• Progesterone treatment may be offered
• Cervical cerclage in some cases

Previous Gestational Diabetes

• Early glucose testing
• Lifestyle advice from early pregnancy
• Close monitoring

Previous Stillbirth

• Investigation of cause if known
• Consultant-led care
• Enhanced monitoring
• Planned timing of delivery

Previous Caesarean Section

• Discussion of delivery options (VBAC vs repeat caesarean)
• Monitoring for scar complications
• Birth planning consultation

Pre-existing Medical Conditions

Chronic Hypertension

Management:

• Medication review (some drugs not safe in pregnancy)
• Regular blood pressure monitoring
• Watch for superimposed pre-eclampsia
• Growth scans
• Planned delivery timing

Type 1 and Type 2 Diabetes

Pre-pregnancy:

• Optimise blood sugar control before conception
• Folic acid 5mg daily
• Medication review

During pregnancy:

• Tight blood sugar control
• Frequent monitoring
• Regular scans
• Consultant-led care
• Planned delivery (usually 37-38 weeks)

Thyroid Disorders

Hypothyroidism:

• Regular thyroid function tests
• Dose adjustments as pregnancy progresses

Hyperthyroidism:

• Medication adjustment
• Monitoring for fetal effects

Autoimmune Conditions

Lupus, antiphospholipid syndrome, rheumatoid arthritis:

• Pre-pregnancy counselling
• Medication review
• Low-dose aspirin
• Close monitoring for complications
• Multidisciplinary care

Blood Clotting Disorders

• Assessment of thrombosis risk
• Blood thinning medication if needed
• Compression stockings
• Monitoring throughout pregnancy

Advanced Maternal Age

Pregnancy at age 35 and over carries some additional considerations:

Increased risks:

• Chromosomal abnormalities (Down syndrome)
• Miscarriage
• Gestational diabetes
• Pre-eclampsia
• Placenta previa
• Caesarean section
• Stillbirth

Our approach:

• Genetic screening options (NIPT, combined screening)
• Regular monitoring
• Growth scans in third trimester
• Discussion of delivery timing

Our High-Risk Pregnancy Care

What We Offer

Consultant-led care:

• Direct care from specialist obstetricians
• Personalised care plans
• Accessible support throughout pregnancy

Enhanced monitoring:

• More frequent antenatal visits
• Additional ultrasound scans
• Specialised tests as needed
• Growth and wellbeing monitoring

Multidisciplinary approach:

• Collaboration with other specialists (diabetologists, cardiologists, etc.)
• Anaesthetic review when needed
• Neonatal team involvement
• Mental health support

Birth planning:

• Detailed discussion of delivery options
• Timing of delivery
• Mode of delivery
• Place of delivery
• Emergency planning

Monitoring Tools

• Ultrasound scans — Growth, fluid levels, placental function
• Doppler studies — Blood flow to baby
• CTG monitoring — Baby’s heart rate patterns
• Blood tests — Checking for complications
• Blood pressure monitoring — At every visit and home monitoring if needed

When to Seek Urgent Help

Contact us immediately or go to hospital if you experience:

• Severe headache that doesn’t go away
• Visual disturbances
• Severe swelling of face or hands
• Pain below ribs, especially on the right
• Vaginal bleeding
• Reduced baby movements
• Regular painful contractions before 37 weeks
• Waters breaking
• Severe abdominal pain
• Feeling very unwell

Frequently Asked Questions

Will I definitely have complications because I’m high-risk? No. Being high-risk means you need closer monitoring, not that problems will definitely occur. Many high-risk pregnancies proceed smoothly with appropriate care.

Can I still have a vaginal delivery? Many women with high-risk pregnancies can still deliver vaginally. This depends on your specific situation and will be discussed individually.

Will I need to deliver early? Some high-risk conditions require earlier delivery for safety. Your team will discuss optimal timing based on your circumstances.

How often will I have appointments? This varies depending on your risk factors. High-risk pregnancies typically require more frequent visits than standard antenatal care.

Can I continue working? This depends on your specific condition and type of work. We can provide advice and documentation if you need workplace adjustments.

Book a Consultation

If you have risk factors for a high-risk pregnancy or have been told your pregnancy is high-risk, our specialist team is here to provide the care you need. Contact us at info@salamivf.com or call +973 1725 5095 to schedule an appointment.

6 - Birth & Delivery Services

Our Birth and Delivery Services ensure you receive expert care when the time comes to welcome your baby. Dr Salam Jibrel provides obstetric services at several leading hospitals across Bahrain, giving you the flexibility to choose a facility that best suits your needs and preferences.

Our Partner Hospitals

We provide birth and delivery services at the following hospitals in Bahrain:

• Bahrain Specialist Hospital
• Al Salam Hospital
• Awali Hospital
• And other facilities upon request

Each hospital offers modern labour and delivery suites, operating theatres for caesarean sections, and neonatal care facilities to ensure the safety of you and your baby.

Types of Delivery

Vaginal Delivery

Vaginal birth is the most natural way to deliver your baby. We support and encourage vaginal delivery when it is safe for both mother and baby.

What to expect:

• Continuous monitoring of you and your baby during labour
• Support from experienced midwives and nursing staff
• Various positions for labour and delivery based on your comfort
• Immediate skin-to-skin contact after birth

Caesarean Section (C-Section)

A caesarean section may be planned in advance or performed as an emergency if needed. Our team is experienced in both elective and emergency caesarean deliveries.

Reasons for planned caesarean:

• Placenta previa (low-lying placenta)
• Breech or transverse baby position
• Multiple pregnancy (twins, triplets)
• Previous caesarean sections
• Maternal health conditions
• Large baby or small pelvis

What to expect:

• Spinal or epidural anaesthesia (you remain awake)
• Your partner can usually be present
• Baby delivered within minutes of starting
• Immediate skin-to-skin when possible
• Recovery in hospital for 2-3 days

Vaginal Birth After Caesarean (VBAC)

If you’ve had a previous caesarean section, you may be a candidate for vaginal birth in your next pregnancy. We will discuss your individual circumstances and help you make an informed decision about the safest delivery option for you.

Pain Relief Options

We offer various pain relief options to help you manage labour:

Non-Medical Options

• Movement and position changes
• Breathing techniques
• Water therapy (where available)
• Massage and support from birth partners

Medical Options

• Entonox (gas and air) — Inhaled pain relief you control yourself
• Pethidine injection — Pain-relieving injection given into the muscle
• Epidural anaesthesia — Regional anaesthesia providing significant pain relief while you remain alert

We will discuss your pain relief preferences during your antenatal appointments so you can make an informed choice.

Preparing for Delivery

Before Your Due Date

• Hospital bag — Pack essentials for you and baby (we can provide a checklist)
• Birth preferences — Discuss your wishes with Dr Salam during antenatal visits
• Hospital registration — Complete pre-admission paperwork at your chosen hospital
• Emergency contacts — Ensure we have your contact details and those of your support person

Signs of Labour

Contact us or go to the hospital if you experience:

• Regular contractions becoming stronger and closer together
• Waters breaking (clear or slightly pink fluid)
• Heavy bleeding
• Reduced baby movements
• Severe headache or visual disturbances
• Severe abdominal pain

When to Go to the Hospital

• First baby: When contractions are 5 minutes apart, lasting 1 minute, for at least 1 hour
• Subsequent babies: When contractions become regular and strong
• Immediately: If your waters break, you have heavy bleeding, or reduced baby movements

What Happens During Labour

Stage 1: Early and Active Labour

• Cervix dilates from 0 to 10 cm
• Contractions become stronger and more frequent
• Regular monitoring of baby’s heartbeat
• Support and pain relief as needed

Stage 2: Pushing and Birth

• You will feel the urge to push
• Guided pushing with each contraction
• Baby is born
• Cord is clamped and cut (delayed cord clamping available)

Stage 3: Delivery of Placenta

• Placenta is delivered shortly after the baby
• You and baby begin bonding and breastfeeding

After Delivery

Immediate Postnatal Care

• Skin-to-skin contact with your baby
• Support with first breastfeed
• Baby checks and measurements
• Monitoring of your recovery

Hospital Stay

• Vaginal delivery: Usually 24-48 hours
• Caesarean section: Usually 2-3 days

Before Discharge

• Newborn examination by a paediatrician
• Hearing screening for baby
• Guidance on newborn care and feeding
• Postnatal follow-up appointment scheduled
• Birth certificate documentation assistance

Postnatal Follow-Up

We provide postnatal care to ensure your recovery is progressing well:

• 1-2 weeks after delivery — Check on your physical recovery and emotional wellbeing
• 6 weeks postnatal — Comprehensive postnatal check-up
• Breastfeeding support and advice
• Discussion of contraception options
• Referral to specialists if needed

Emergency Care

Our team is prepared to handle any complications that may arise during labour and delivery:

• 24/7 access to operating theatres for emergency caesarean sections
• Experienced anaesthesia team
• Blood transfusion services available
• Neonatal intensive care unit (NICU) access at partner hospitals
• Direct communication with Dr Salam throughout your labour

Choosing Your Hospital

When selecting which hospital to deliver at, consider:

• Location and distance from your home
• Facilities available (private rooms, NICU level)
• Your insurance coverage
• Previous experiences or preferences

We can help you choose the best option based on your individual circumstances and any risk factors in your pregnancy.

Book a Consultation

If you’re pregnant and would like to discuss your birth and delivery options, or if you’d like to transfer your care to us, we’re here to help. Contact us at info@salamivf.com or call +973 1725 5095 to schedule an appointment.

7 - Pregnancy Scans

Our Pregnancy Scan Services provide detailed ultrasound assessments throughout your pregnancy. From early pregnancy scans to detailed anomaly scans and specialist twin monitoring, we offer comprehensive imaging to ensure the health and wellbeing of you and your baby.

Types of Pregnancy Scans

• Early pregnancy scan (6-10 weeks)
• Dating scan (10-14 weeks)
• Nuchal translucency scan (11-14 weeks)
• Detailed anomaly scan (18-22 weeks)
• Growth scans (third trimester)
• Twin pregnancy scans
• 3D/4D scans
• Doppler assessments

Early Pregnancy Scan (6-10 Weeks)

What Is It?

An early pregnancy scan confirms pregnancy location, viability, and dates. It’s often performed transvaginally for clearer images in early pregnancy.

What We Check

• Pregnancy is in the correct location (uterus)
• Heartbeat is present
• Number of babies
• Estimated due date
• Any early concerns

When to Have This Scan

• After a positive pregnancy test
• If you have had previous miscarriage or ectopic pregnancy
• If you have pain or bleeding
• After fertility treatment
• For reassurance

Dating Scan (10-14 Weeks)

What Is It?

The dating scan accurately determines your due date and checks that your baby is developing normally. It’s usually performed abdominally.

What We Check

• Crown-rump length (CRL) to calculate due date
• Baby’s heartbeat
• Number of babies
• Basic anatomy check
• Position of the placenta

Importance of Accurate Dating

• Ensures correct timing of screening tests
• Important for monitoring growth later in pregnancy
• Helps plan delivery timing if needed

Nuchal Translucency Scan (11-14 Weeks)

What Is It?

The nuchal translucency (NT) scan is a screening test for chromosomal abnormalities, including Down syndrome, Edwards syndrome, and Patau syndrome. It measures the fluid at the back of the baby’s neck.

What We Measure

• Nuchal translucency thickness
• Crown-rump length
• Nasal bone presence
• Heart rate

Combined Screening

The NT measurement is combined with:

• Maternal age
• Blood tests (PAPP-A and free beta-hCG)
• To give a risk assessment for chromosomal conditions

Results

• Low risk: Less than 1 in 150
• Higher risk: Further testing options discussed (NIPT or amniocentesis)

Detailed Anomaly Scan (18-22 Weeks)

What Is It?

The detailed anomaly scan, also called the 20-week scan or mid-pregnancy scan, is a comprehensive examination of your baby’s anatomy. This is one of the most important scans during pregnancy.

Why Is It Important?

This scan checks your baby’s organs and structures in detail to identify any abnormalities. Most babies are found to be developing normally, but early detection of problems allows for:

• Specialist consultation
• Planning for delivery and treatment
• Parental preparation
• Further testing if needed

What We Examine

Head and brain:

• Skull shape and structure
• Brain development
• Ventricles (fluid spaces)
• Cerebellum
• Face profile

Face:

• Eyes
• Nose and lips (cleft lip screening)
• Jaw

Spine:

• Each vertebra checked
• Spinal cord
• Skin covering

Heart:

• Four chambers
• Major blood vessels
• Heart rhythm
• Blood flow patterns

Chest:

• Lungs
• Diaphragm

Abdomen:

• Stomach
• Kidneys
• Bladder
• Abdominal wall
• Umbilical cord insertion

Limbs:

• Arms and hands
• Legs and feet
• Fingers and toes (when visible)

Other checks:

• Placenta position and appearance
• Amniotic fluid volume
• Umbilical cord (three vessels)
• Cervical length

Gender

We can usually determine gender at this scan if you wish to know. Please let us know your preference at the start of the appointment.

Limitations

Some conditions cannot be detected on ultrasound, including:

• Some heart defects
• Some genetic conditions
• Conditions that develop later in pregnancy
• Functional problems

Detection rates vary depending on the condition, baby’s position, and maternal factors.

What to Expect

• Duration: 30-45 minutes
• Full bladder may be helpful but not always required
• Baby’s position affects the scan — you may need to walk around if baby is not in an optimal position
• Some images may require a repeat scan

If Something Is Found

If an abnormality is suspected:

• We will explain the findings clearly
• Referral to a specialist (fetal medicine) may be arranged
• Further tests may be offered
• Support and counselling available
• You will have time to ask questions

Growth Scans (Third Trimester)

When Are They Needed?

Growth scans monitor your baby’s size and wellbeing. They may be recommended if you have:

• High-risk pregnancy
• Concerns about baby’s growth (too small or too large)
• Reduced fetal movements
• Diabetes (gestational or pre-existing)
• High blood pressure or pre-eclampsia
• Multiple pregnancy
• Previous small or large baby
• Placental concerns

What We Measure

Baby’s measurements:

• Head circumference (HC)
• Abdominal circumference (AC)
• Femur length (FL)
• Estimated fetal weight (EFW)

Wellbeing assessments:

• Amniotic fluid volume
• Baby’s movements
• Breathing movements
• Muscle tone
• Doppler blood flow studies

Doppler Assessment

Doppler ultrasound measures blood flow in:

• Umbilical artery — blood flow from baby to placenta
• Middle cerebral artery — blood flow to baby’s brain
• Uterine arteries — blood flow to the placenta
• Ductus venosus — blood flow through baby’s liver

Abnormal Doppler findings can indicate placental insufficiency and help guide delivery timing.

Twin Pregnancy Scans

Why Do Twins Need More Scans?

Twin pregnancies require closer monitoring because of increased risks:

• Preterm birth
• Growth problems
• Twin-to-twin transfusion syndrome (TTTS) in identical twins
• Complications specific to multiple pregnancy

Types of Twin Pregnancy

Understanding your twin type is essential for planning care:

DCDA Twin Scans (Dichorionic Diamniotic)

Schedule:

• Dating scan (11-14 weeks)
• Anomaly scan (18-22 weeks)
• Growth scans every 4 weeks from 20 weeks
• Delivery usually planned around 37 weeks

What we check:

• Growth of each baby
• Amniotic fluid around each baby
• Placenta positions
• Cervical length

MCDA Twin Scans (Monochorionic Diamniotic)

Schedule:

• Dating scan (11-14 weeks)
• Scans every 2 weeks from 16 weeks
• Anomaly scan (18-22 weeks)
• Continued fortnightly scans until delivery
• Delivery usually planned around 36 weeks

What we check:

• Growth discordance (difference in size between twins)
• Amniotic fluid levels (polyhydramnios/oligohydramnios)
• Signs of twin-to-twin transfusion syndrome (TTTS)
• Doppler blood flow studies
• Cervical length

Twin-to-Twin Transfusion Syndrome (TTTS)

TTTS affects MCDA twins who share a placenta. Blood vessels in the placenta can cause unequal blood sharing between the twins.

Signs we look for:

• One twin with too much fluid (recipient)
• One twin with too little fluid (donor)
• Bladder differences
• Growth discordance
• Abnormal Doppler findings

If TTTS is suspected:

• Referral to fetal medicine specialist
• Staging of severity
• Treatment options discussed (laser therapy)
• Close monitoring

MCMA Twin Scans (Monochorionic Monoamniotic)

These twins share both placenta and amniotic sac, requiring the most intensive monitoring.

Schedule:

• Weekly scans from 16 weeks
• Hospital admission often recommended from 26-28 weeks
• Daily monitoring
• Delivery usually planned around 32-34 weeks

Additional concerns:

• Cord entanglement
• TTTS
• Growth discordance

3D/4D Scans

What Are They?

• 3D scan — Creates a still three-dimensional image of your baby
• 4D scan — Creates a moving three-dimensional video of your baby

Best Time

• 26-32 weeks for best images
• Baby’s position and fluid levels affect image quality

What You Can See

• Baby’s face and features
• Expressions (yawning, smiling)
• Movements
• Hands and feet

Limitations

3D/4D scans are primarily for bonding and keepsake images. They are not a substitute for medical diagnostic scans.

Booking Your Scan

How to Book

Contact us to schedule your pregnancy scan:

• Phone: +973 1725 5095
• Email: info@salamivf.com

What to Bring

• Referral letter (if applicable)
• Previous scan reports
• Maternity notes
• List of any concerns or questions

Preparing for Your Scan

Early pregnancy scan:

• May require a full bladder
• Transvaginal scan may be needed

Later scans:

• No special preparation usually needed
• Wear comfortable, loose clothing
• Eat and drink normally

Understanding Your Results

After each scan, we will:

• Explain the findings to you
• Provide written report
• Give you images of your baby
• Discuss any concerns or next steps
• Arrange follow-up if needed

Frequently Asked Questions

Are ultrasound scans safe? Yes. Ultrasound has been used in pregnancy for decades and there is no evidence of harm to mother or baby when used appropriately.

How long do scans take?

• Early/dating scan: 15-20 minutes
• Anomaly scan: 30-45 minutes
• Growth scan: 20-30 minutes
• Twin scans: 30-60 minutes

Can I bring my partner/family? Yes, we welcome you to bring a support person to share this experience.

What if my baby is not in a good position? We may ask you to walk around, have a cold drink, or return for a repeat scan to get the images we need.

Will I always get clear images? Image quality depends on baby’s position, amniotic fluid levels, maternal body habitus, and gestational age. We will do our best to obtain the views needed.

Can you always tell the gender? In most cases, yes, at the 20-week scan. However, baby’s position may make it difficult sometimes.

Book Your Pregnancy Scan

Whether you need an early reassurance scan, your detailed anomaly scan, or specialist twin monitoring, our experienced team is here to provide expert care throughout your pregnancy. Contact us at info@salamivf.com or call +973 1725 5095 to book your appointment.

8 - Genetic Testing Services

Our Genetic Testing Services offer advanced screening and diagnostic options to help you make informed decisions about your fertility treatment and pregnancy. Using cutting-edge technology, we can identify genetic conditions and chromosomal abnormalities to improve your chances of a healthy pregnancy.

Why Genetic Testing?

Genetic testing can help:

• Identify embryos with the best chance of successful implantation
• Reduce the risk of miscarriage
• Screen for inherited genetic conditions
• Detect chromosomal abnormalities early in pregnancy
• Provide information for informed family planning decisions

Our Genetic Testing Services

PGT-A (Preimplantation Genetic Testing for Aneuploidy)

What is it? PGT-A screens embryos created through IVF for chromosomal abnormalities (aneuploidy) before transfer. Embryos with the correct number of chromosomes have a higher chance of implantation and healthy pregnancy.

Who should consider PGT-A?

• Women aged 35 and over
• Couples with recurrent miscarriage
• Couples with previous failed IVF cycles
• Couples with a history of chromosomally abnormal pregnancies

How it works:

1. Embryos are created through IVF/ICSI
2. A small biopsy is taken from each embryo at the blastocyst stage (day 5-6)
3. The cells are analysed for chromosomal abnormalities
4. Only chromosomally normal embryos are selected for transfer

PGT-M (Preimplantation Genetic Testing for Monogenic Disorders)

What is it? PGT-M tests embryos for specific inherited genetic conditions when one or both parents are known carriers of a genetic disorder.

Conditions that can be tested:

• Sickle cell disease
• Thalassemia
• Cystic fibrosis
• Spinal muscular atrophy (SMA)
• Huntington’s disease
• BRCA gene mutations
• Many other single-gene disorders

Who should consider PGT-M?

• Known carriers of genetic conditions
• Couples with a family history of genetic disorders
• Couples who have had a child affected by a genetic condition

PGD (Preimplantation Genetic Diagnosis)

What is it? PGD is the original term for genetic testing of embryos, now largely replaced by PGT-M and PGT-A. It refers to testing embryos for specific genetic conditions before transfer during IVF treatment.

Benefits:

• Prevents transmission of genetic diseases to children
• Avoids the difficult decision of terminating an affected pregnancy
• Allows couples with genetic conditions to have healthy biological children

NIPT (Non-Invasive Prenatal Testing)

What is it? NIPT is a highly accurate blood test performed during pregnancy that screens for common chromosomal conditions by analysing cell-free fetal DNA in the mother’s blood.

What does NIPT screen for?

• Down syndrome (Trisomy 21)
• Edwards syndrome (Trisomy 18)
• Patau syndrome (Trisomy 13)
• Sex chromosome conditions
• Fetal sex determination (optional)

When is it performed? NIPT can be done from 10 weeks of pregnancy onwards.

Who should consider NIPT?

• All pregnant women seeking reassurance
• Women with abnormal first trimester screening results
• Women aged 35 and over
• Women with a previous pregnancy affected by chromosomal abnormality
• Women who want to avoid invasive testing (amniocentesis)

Advantages of NIPT:

• Non-invasive (simple blood test)
• No risk to the pregnancy
• Highly accurate (>99% for common trisomies)
• Early results (from 10 weeks)

ERA Test (Endometrial Receptivity Analysis)

What is it? The ERA test analyses the endometrial lining to determine the optimal window for embryo transfer, helping to personalise the timing of your frozen embryo transfer.

Who should consider ERA?

• Women with recurrent implantation failure
• Women who have had good quality embryos but unsuccessful transfers
• Women undergoing frozen embryo transfer

How it works:

1. A small biopsy of the endometrial lining is taken
2. The sample is analysed to determine receptivity status
3. Results indicate if your endometrium is receptive, pre-receptive, or post-receptive
4. Your embryo transfer is timed according to your personalised window

The Testing Process

For PGT-A/PGT-M:

1. Consultation — Discussion of your medical history and testing options
2. IVF cycle — Ovarian stimulation, egg retrieval, and fertilisation
3. Embryo culture — Embryos are grown to blastocyst stage (day 5-6)
4. Biopsy — A few cells are carefully removed from each embryo
5. Analysis — Samples are sent to a specialist genetics laboratory
6. Results — Usually available within 1-2 weeks
7. Embryo transfer — Healthy embryos are transferred or frozen for later use

For NIPT:

1. Blood draw — Simple blood sample from the mother
2. Laboratory analysis — Cell-free DNA is analysed
3. Results — Usually available within 7-10 days
4. Consultation — Discussion of results and next steps if needed

Understanding Your Results

Our team will explain your results in detail, including:

• What the results mean for your pregnancy or treatment
• Any additional testing that may be recommended
• Your options based on the findings
• Support resources available to you

Genetic Counselling

We offer genetic counselling to help you:

• Understand your genetic testing options
• Interpret test results
• Make informed decisions about your care
• Access emotional support throughout the process

Book a Consultation

If you’re interested in genetic testing or would like to learn more about your options, our team is here to help. Contact us at info@salamivf.com or call +973 1725 5095 to schedule a consultation.

9 - Fertility Preservation & Freezing Services

Our Fertility Preservation and Freezing Services offer you the opportunity to preserve your fertility for the future. Using advanced vitrification technology, we can safely freeze and store embryos, eggs, and sperm for use when the time is right for you.

Why Consider Fertility Preservation?

Fertility preservation allows you to:

• Delay family building while pursuing career or educational goals
• Preserve fertility before medical treatments that may affect it (chemotherapy, radiation)
• Store excess embryos from IVF cycles for future use
• Have backup options if initial fertility treatment cycles don’t succeed
• Preserve fertility before age-related decline

Embryo Freezing (Embryo Cryopreservation)

What Is Embryo Freezing?

Embryo freezing involves preserving embryos created through IVF at ultra-low temperatures using a technique called vitrification. These embryos can be stored for many years and thawed for use in future fertility treatment cycles.

Who Should Consider Embryo Freezing?

• Couples undergoing IVF who have excess good-quality embryos
• Couples who wish to delay embryo transfer (for medical or personal reasons)
• Couples who want to preserve embryos for siblings in the future
• Patients facing cancer treatment or other medical procedures that may affect fertility
• Couples who need to postpone transfer due to ovarian hyperstimulation syndrome (OHSS)

The Embryo Freezing Process

1. IVF/ICSI cycle — Eggs are retrieved and fertilised to create embryos
2. Embryo culture — Embryos are grown to the optimal stage (usually blastocyst, day 5-6)
3. Selection — The best quality embryos are selected for freezing
4. Vitrification — Embryos are rapidly frozen using advanced vitrification technology
5. Storage — Embryos are stored in liquid nitrogen at -196°C
6. Thawing — When ready, embryos are carefully thawed for transfer

Success Rates

Frozen embryo transfers (FET) have excellent success rates, often comparable to or even better than fresh embryo transfers. Vitrification technology has significantly improved embryo survival rates, with over 95% of embryos surviving the thaw process.

Storage Duration

Embryos can be stored for many years without loss of quality. Annual storage fees apply, and you will be contacted regularly to confirm your wishes regarding continued storage.

Egg Freezing (Oocyte Cryopreservation)

What Is Egg Freezing?

Egg freezing allows women to preserve their unfertilised eggs for future use. This gives women more control over their reproductive timeline by storing eggs at their current quality for use later in life.

Who Should Consider Egg Freezing?

• Women who wish to delay childbearing for personal, professional, or educational reasons
• Women facing cancer treatment or surgery that may affect their ovaries
• Women with a family history of early menopause
• Women with conditions that may affect future fertility (endometriosis, autoimmune disorders)
• Women who haven’t found the right partner but want to preserve their fertility options
• Women undergoing gender-affirming treatment

The Egg Freezing Process

1. Consultation — Assessment of your ovarian reserve and discussion of expectations
2. Ovarian stimulation — Hormone injections to stimulate multiple egg development (10-14 days)
3. Monitoring — Regular ultrasound scans and blood tests to track follicle growth
4. Egg retrieval — Minor procedure to collect eggs under sedation
5. Vitrification — Mature eggs are rapidly frozen using advanced technology
6. Storage — Eggs are stored in liquid nitrogen at -196°C

How Many Eggs Should Be Frozen?

The number of eggs recommended depends on your age at freezing:

• Under 35 years: 10-15 eggs recommended
• 35-37 years: 15-20 eggs recommended
• 38-40 years: 20-25 eggs recommended

Multiple stimulation cycles may be needed to achieve the recommended number of eggs.

When to Use Your Frozen Eggs

When you’re ready to use your frozen eggs:

1. Eggs are thawed
2. Eggs are fertilised using ICSI (sperm injection)
3. Embryos are cultured and monitored
4. The best embryo(s) are transferred to your uterus
5. Pregnancy test approximately two weeks later

Important Considerations

• Egg freezing success rates decrease with age at freezing
• Not all frozen eggs will survive thawing, fertilise, or develop into viable embryos
• Freezing eggs earlier (ideally before 35) gives the best chance of future success
• Egg freezing is a fertility preservation option, not a guarantee of pregnancy

Sperm Freezing (Sperm Cryopreservation)

What Is Sperm Freezing?

Sperm freezing allows men to preserve their sperm for future use in fertility treatments. Frozen sperm can be used for IUI, IVF, or ICSI procedures.

Who Should Consider Sperm Freezing?

• Men facing cancer treatment (chemotherapy, radiation, surgery)
• Men undergoing vasectomy who may want children in the future
• Men with declining sperm quality
• Men in high-risk occupations or military deployment
• Men who may have difficulty producing a sample on the day of treatment
• Transgender women before hormone therapy
• Men using donor sperm as a backup option

The Sperm Freezing Process

1. Consultation — Discussion of your needs and medical history
2. Screening tests — Blood tests for infectious diseases (HIV, Hepatitis B & C)
3. Sample collection — Sperm sample produced at the clinic or brought from home
4. Analysis — Semen analysis to assess sperm quality
5. Processing — Sperm is prepared and mixed with cryoprotectant
6. Freezing — Sample is gradually frozen and stored in liquid nitrogen
7. Storage — Sperm is stored at -196°C until needed

Sample Collection Options

• At the clinic — Private room available for sample production
• Home collection — Sample can be produced at home and brought to the clinic within one hour
• Surgical retrieval — For men who cannot produce a sample naturally (PESA, TESA, or micro-TESE)

Success Rates

Sperm typically freezes well, with most samples retaining good quality after thawing. However, some reduction in motility is normal. The fertility potential of frozen sperm remains excellent when used with appropriate techniques (IUI, IVF, or ICSI).

Storage Duration

Sperm can be stored for many years without significant deterioration. Annual storage fees apply, and we will contact you regularly regarding continued storage.

Vitrification Technology

All our freezing services use vitrification, the most advanced freezing technique available:

What Is Vitrification?

Vitrification is an ultra-rapid freezing method that prevents ice crystal formation within cells. This results in:

• Higher survival rates after thawing
• Better preservation of cell quality
• Improved success rates compared to older slow-freezing methods

How It Works

Cells are exposed to cryoprotectants and then plunged directly into liquid nitrogen, cooling at approximately 20,000°C per minute. This rapid cooling prevents ice crystals from forming, which could damage the cells.

Storage and Management

Our Storage Facility

• State-of-the-art cryopreservation laboratory
• Liquid nitrogen storage tanks with continuous monitoring
• 24/7 alarm systems and backup power
• Strict quality control and chain of custody procedures

Storage Fees

• Storage fees are charged annually
• Payment reminders are sent before each renewal period
• Fees must be kept current to maintain storage
• Contact us for current pricing information

Consent and Decision Making

• Written consent is required for all freezing procedures
• Consent forms specify how long samples will be stored
• Consent includes instructions for various scenarios (separation, death)
• Consent can be updated at any time

Frequently Asked Questions

How long can eggs/embryos/sperm be stored? Technically, frozen cells can be stored indefinitely without loss of quality. Storage duration is subject to local regulations and your personal wishes.

Is freezing safe for future babies? Yes. Extensive research shows no increased risk of birth defects or health problems in children born from frozen eggs, embryos, or sperm.

What happens if I no longer need my frozen samples? You can choose to discard them, donate them to research (where permitted), or in some cases donate embryos to other couples (where legally allowed).

Can I transport my frozen samples to another clinic? Yes. Samples can be transported to other facilities using specialised cryogenic shipping containers. We can arrange this for you.

Book a Consultation

If you’re considering fertility preservation or would like to learn more about our freezing services, our team is here to help. Contact us at info@salamivf.com or call +973 1725 5095 to schedule a consultation.

10 - Endometriosis Services

Our Endometriosis Services provide comprehensive diagnosis, treatment, and ongoing management for women living with this often challenging condition. We understand the impact endometriosis can have on your quality of life and fertility, and our team is dedicated to providing compassionate, expert care.

What Is Endometriosis?

Endometriosis is a condition where tissue similar to the lining of the uterus (endometrium) grows outside the uterus. This tissue can be found on the ovaries, fallopian tubes, bowel, bladder, and other areas within the pelvis.

Like the normal uterine lining, this tissue responds to hormonal changes during the menstrual cycle, causing inflammation, pain, and the formation of scar tissue (adhesions).

How Common Is Endometriosis?

• Affects approximately 1 in 10 women of reproductive age
• Often takes 7-10 years to diagnose due to symptom variability
• Can begin in adolescence and continue until menopause
• May run in families (genetic component)

Symptoms of Endometriosis

Endometriosis symptoms vary greatly from woman to woman. Some women have severe symptoms while others have none at all.

Common Symptoms

• Painful periods (dysmenorrhoea) — Pain that is more severe than normal menstrual cramps
• Chronic pelvic pain — Pain that persists throughout the month, not just during periods
• Pain during or after intercourse (dyspareunia)
• Pain with bowel movements or urination — Especially during menstruation
• Heavy or irregular periods
• Fatigue — Persistent tiredness that affects daily life
• Infertility — Difficulty getting pregnant

Less Common Symptoms

• Lower back pain
• Leg pain (sciatica-like symptoms)
• Bloating (“endo belly”)
• Nausea
• Blood in urine or stool during periods

When to Seek Help

You should consult a specialist if you experience:

• Pelvic pain that interferes with daily activities
• Painful periods that don’t respond to standard painkillers
• Pain during intercourse
• Difficulty conceiving after 12 months of trying
• Worsening symptoms over time

Diagnosis

Medical History and Examination

Your consultation will include:

• Detailed discussion of your symptoms and their pattern
• Menstrual history and pain diary review
• Family history of endometriosis
• Pelvic examination

Ultrasound

Transvaginal ultrasound can identify:

• Ovarian endometriomas (chocolate cysts)
• Deep infiltrating endometriosis in some locations
• Other pelvic abnormalities

MRI Scan

MRI may be recommended for:

• Detailed assessment of deep endometriosis
• Planning surgical treatment
• Evaluating involvement of bowel, bladder, or other organs

Laparoscopy

Laparoscopy (keyhole surgery) remains the gold standard for definitive diagnosis:

• Allows direct visualisation of endometriosis deposits
• Enables biopsy for confirmation
• Treatment can often be performed at the same time
• Determines the stage and extent of disease

Stages of Endometriosis

Endometriosis is classified into four stages based on the location, extent, and depth of the disease:

Important: The stage does not always correlate with the severity of symptoms. Some women with Stage I have severe pain, while others with Stage IV have minimal symptoms.

Treatment Options

Treatment is tailored to your individual circumstances, including symptom severity, desire for pregnancy, and previous treatments.

Pain Management

• Over-the-counter pain relief — NSAIDs (ibuprofen, naproxen) taken before and during periods
• Heat therapy — Hot water bottles or heating pads for pain relief
• TENS machines — Transcutaneous electrical nerve stimulation

Hormonal Treatments

Hormonal therapies work by suppressing ovulation and reducing oestrogen levels:

• Combined oral contraceptive pill — Continuous use to prevent periods
• Progestogen-only treatments — Pills, injections, or implants
• Mirena coil (IUS) — Releases progestogen directly into the uterus
• GnRH agonists — Temporarily induce a menopause-like state
• GnRH antagonists — Newer option with fewer side effects

Surgical Treatment

Surgery may be recommended when:

• Medical treatments have not provided adequate relief
• There are ovarian cysts (endometriomas)
• You are trying to conceive
• There is deep infiltrating endometriosis

Types of surgery:

• Laparoscopic excision — Cutting out endometriosis deposits (preferred method)
• Laparoscopic ablation — Burning or destroying endometriosis tissue
• Cystectomy — Removal of ovarian endometriomas
• Adhesiolysis — Releasing scar tissue and adhesions
• Hysterectomy — Removal of the uterus (for severe cases when fertility is not desired)

Complementary Therapies

Some women find relief with:

• Dietary changes (anti-inflammatory diet)
• Acupuncture
• Physiotherapy for pelvic floor
• Psychological support and pain management programmes

Endometriosis and Fertility

Endometriosis is one of the leading causes of infertility, affecting up to 50% of women who have difficulty conceiving.

How Endometriosis Affects Fertility

• Damages or blocks fallopian tubes
• Creates adhesions that distort pelvic anatomy
• Affects egg quality in ovarian endometriomas
• Creates an inflammatory environment that may affect implantation
• Can impact ovarian reserve

Fertility Treatment Options

Surgical treatment:

• Removing endometriosis and adhesions can improve natural conception rates
• Particularly beneficial for mild to moderate endometriosis
• Should be performed by an experienced surgeon to preserve ovarian tissue

IVF (In Vitro Fertilisation):

• Often recommended for moderate to severe endometriosis
• Recommended after failed surgical treatment
• Bypasses damaged fallopian tubes
• May require individualised stimulation protocols

IUI (Intrauterine Insemination):

• May be suitable for minimal/mild endometriosis
• Usually combined with ovarian stimulation
• Less invasive than IVF

Preserving Fertility

If you have endometriosis and are not ready to conceive, consider:

• Egg freezing to preserve fertility for the future
• Regular monitoring of ovarian reserve
• Early fertility consultation to understand your options

Living with Endometriosis

Long-term Management

Endometriosis is a chronic condition that requires ongoing management:

• Regular follow-up appointments
• Monitoring for disease progression
• Adjusting treatment as needed
• Managing symptoms between appointments

Support Resources

• Support groups (online and local)
• Endometriosis associations and charities
• Counselling and psychological support
• Pain management clinics

Lifestyle Modifications

Some women find these helpful:

• Regular exercise
• Stress management techniques
• Adequate sleep
• Anti-inflammatory diet
• Limiting alcohol and caffeine

Our Approach

At Dr Salam Jibrel Medical Center, we provide:

• Expert diagnosis — Using the latest imaging and surgical techniques
• Individualised treatment plans — Tailored to your symptoms and goals
• Fertility-focused care — Preserving and optimising your fertility
• Multidisciplinary approach — Collaboration with pain specialists, physiotherapists, and psychologists when needed
• Ongoing support — Long-term management and follow-up

Book a Consultation

If you’re experiencing symptoms of endometriosis or have been diagnosed and need specialist care, our team is here to help. Contact us at info@salamivf.com or call +973 1725 5095 to schedule a consultation.

11 - Benign Gynaecology Services

Our Benign Gynaecology Services provide comprehensive care for a wide range of non-cancerous gynaecological conditions. From heavy periods and fibroids to cervical screening and preventive care, our experienced team is here to diagnose, treat, and support you through your gynaecological health journey.

Our Benign Gynaecology Services Include

• Heavy menstrual bleeding (menorrhagia)
• Adenomyosis
• Uterine fibroids
• Ovarian cysts
• Cervical smears and screening
• HPV vaccination
• Pelvic pain
• Polycystic ovary syndrome (PCOS)
• Menstrual disorders
• Contraception advice
• Menopause management

Heavy Menstrual Bleeding (Menorrhagia)

What Is Heavy Menstrual Bleeding?

Heavy menstrual bleeding is defined as blood loss that interferes with your physical, social, or emotional quality of life. This may include:

• Bleeding that soaks through a pad or tampon every hour for several hours
• Needing to use double protection (pad and tampon)
• Bleeding for more than 7 days
• Passing blood clots larger than a 10p coin
• Needing to change pads during the night
• Symptoms of anaemia (tiredness, shortness of breath, pallor)

Causes

• Hormonal imbalance
• Uterine fibroids
• Adenomyosis
• Polyps
• Bleeding disorders
• Thyroid problems
• Sometimes no cause is found (dysfunctional uterine bleeding)

Diagnosis

• Medical history and symptom assessment
• Blood tests (full blood count, iron levels, thyroid function)
• Pelvic ultrasound
• Hysteroscopy (camera examination of the uterus)
• Endometrial biopsy if indicated

Treatment Options

Medical treatments:

• Tranexamic acid (reduces bleeding)
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Combined oral contraceptive pill
• Progestogen treatments (tablets, injections, implant)
• Mirena coil (IUS) — highly effective, reduces bleeding by up to 90%

Surgical treatments:

• Hysteroscopic polypectomy (removal of polyps)
• Endometrial ablation (destruction of the uterine lining)
• Myomectomy (removal of fibroids)
• Hysterectomy (removal of the uterus — definitive treatment)

Adenomyosis

What Is Adenomyosis?

Adenomyosis occurs when the tissue that normally lines the uterus (endometrium) grows into the muscular wall of the uterus. This causes the uterus to enlarge and can lead to heavy, painful periods.

Symptoms

• Heavy menstrual bleeding
• Severe menstrual cramps
• Chronic pelvic pain
• Pain during intercourse
• Enlarged, tender uterus
• Bloating before periods

Who Is Affected?

• Most common in women aged 40-50
• Women who have had children
• Women who have had uterine surgery (caesarean section, fibroid removal)
• May coexist with endometriosis or fibroids

Diagnosis

• Pelvic examination (enlarged, tender uterus)
• Transvaginal ultrasound
• MRI scan (most accurate for diagnosis)

Treatment

Medical treatments:

• Pain relief (NSAIDs)
• Hormonal treatments (contraceptive pill, progestogens)
• Mirena coil (IUS)
• GnRH agonists (temporary menopause-like state)

Surgical treatments:

• Hysterectomy (definitive treatment)
• Adenomyomectomy (removal of adenomyosis tissue — in selected cases)
• Uterine artery embolisation (in selected cases)

Uterine Fibroids

What Are Fibroids?

Fibroids (also called myomas or leiomyomas) are non-cancerous growths that develop in or around the uterus. They are extremely common, affecting up to 70% of women by age 50.

Types of Fibroids

Symptoms

Many women have no symptoms. When symptoms occur, they may include:

• Heavy or prolonged periods
• Pelvic pain or pressure
• Frequent urination
• Difficulty emptying the bladder
• Constipation
• Backache or leg pain
• Enlarged abdomen
• Fertility problems (depending on location)

Diagnosis

• Pelvic examination
• Transvaginal ultrasound
• MRI scan (for detailed mapping before surgery)
• Hysteroscopy (for submucosal fibroids)

Treatment

Watchful waiting:

• Small, asymptomatic fibroids may not need treatment
• Regular monitoring with ultrasound

Medical treatments:

• Tranexamic acid and NSAIDs for symptom relief
• Hormonal treatments (contraceptive pill, progestogens)
• Mirena coil (IUS)
• GnRH agonists (to shrink fibroids before surgery)
• Ulipristal acetate (in selected cases)

Surgical treatments:

• Hysteroscopic myomectomy (for submucosal fibroids)
• Laparoscopic or open myomectomy (preserves the uterus)
• Hysterectomy (definitive treatment)

Other treatments:

• Uterine artery embolisation (UAE)
• MRI-guided focused ultrasound

Ovarian Cysts

What Are Ovarian Cysts?

Ovarian cysts are fluid-filled sacs that develop on or within the ovaries. Most are harmless and resolve on their own.

Types of Cysts

Functional cysts (most common):

• Follicular cysts — form when the follicle doesn’t release the egg
• Corpus luteum cysts — form after the egg is released

Other types:

• Dermoid cysts (teratomas)
• Endometriomas (chocolate cysts)
• Cystadenomas

Symptoms

Many cysts cause no symptoms. Symptoms may include:

• Pelvic pain or discomfort
• Bloating or swelling
• Pain during intercourse
• Changes in periods
• Difficulty emptying bladder or bowels

When to Seek Urgent Care

• Sudden, severe pelvic pain
• Pain with fever or vomiting
• Dizziness or fainting
• Rapid breathing

These may indicate a ruptured cyst or ovarian torsion (twisting).

Diagnosis

• Pelvic examination
• Ultrasound scan
• Blood tests (including CA-125 if appropriate)
• MRI in selected cases

Treatment

• Watchful waiting — Most functional cysts resolve within 2-3 months
• Pain relief — For symptom management
• Hormonal contraception — May help prevent new cysts
• Surgery — Laparoscopic cystectomy or oophorectomy if needed

Cervical Screening (Smear Tests)

What Is Cervical Screening?

Cervical screening (also called a smear test or Pap test) is a method of detecting abnormal cells on the cervix before they can develop into cervical cancer. It is one of the most effective ways to prevent cervical cancer.

Who Should Have Cervical Screening?

• All women aged 25-65 with a cervix
• Screening intervals depend on local guidelines and previous results
• Women who have had the HPV vaccine should still attend screening

What Happens During a Smear Test?

1. You lie on an examination couch
2. A speculum is gently inserted to visualise the cervix
3. A small brush collects cells from the cervix
4. The sample is sent for laboratory analysis
5. The procedure takes only a few minutes

Understanding Your Results

Normal result:

• No abnormal cells detected
• Routine recall for next screening

Abnormal result:

• Abnormal cells detected — this does not mean cancer
• Further investigation may be recommended (colposcopy)
• Many abnormalities resolve on their own

HPV testing:

• Samples are tested for high-risk HPV
• HPV-positive results require further investigation

Colposcopy

If your smear test shows abnormalities, you may be referred for colposcopy:

• Detailed examination of the cervix using a microscope
• Biopsy may be taken
• Treatment can often be done at the same time (LLETZ procedure)

HPV Vaccination

What Is HPV?

Human papillomavirus (HPV) is a very common virus spread through skin-to-skin contact. Some types of HPV can cause:

• Cervical cancer
• Other genital cancers
• Genital warts
• Throat cancers

HPV Vaccine

The HPV vaccine protects against the types of HPV that cause most cervical cancers and genital warts.

Who should be vaccinated:

• Girls and boys aged 9-14 (most effective before exposure to HPV)
• Catch-up vaccination available for older teenagers and young adults
• Can be given up to age 45 in some cases

Vaccine schedule:

• Two doses, 6-12 months apart (for those under 15)
• Three doses for those 15 and over

Benefits:

• Prevents up to 90% of cervical cancers
• Prevents genital warts
• Protects against other HPV-related cancers

We offer HPV vaccination at our clinic. Contact us for more information.

Pelvic Pain

Causes of Pelvic Pain

Pelvic pain can have many causes, including:

• Endometriosis
• Adenomyosis
• Fibroids
• Ovarian cysts
• Pelvic inflammatory disease (PID)
• Irritable bowel syndrome (IBS)
• Bladder conditions
• Musculoskeletal problems

When to Seek Help

Consult us if you experience:

• Persistent pelvic pain lasting more than 6 months
• Pain affecting daily activities or quality of life
• Pain during intercourse
• Pain with periods that doesn’t respond to painkillers
• Associated symptoms (abnormal bleeding, bowel or bladder problems)

Our Approach

• Detailed history and examination
• Appropriate investigations (ultrasound, blood tests, laparoscopy)
• Multidisciplinary approach when needed
• Individualised treatment plan

Polycystic Ovary Syndrome (PCOS)

What Is PCOS?

PCOS is a common hormonal condition affecting how the ovaries work. It is characterised by:

• Irregular or absent periods
• Excess androgen (male hormones) — causing acne, excess hair growth
• Polycystic ovaries on ultrasound

Symptoms

• Irregular, infrequent, or absent periods
• Difficulty getting pregnant
• Excess facial or body hair (hirsutism)
• Acne
• Weight gain
• Thinning hair or hair loss from the scalp
• Skin darkening (acanthosis nigricans)

Diagnosis

Diagnosis requires two of the following three criteria:

1. Irregular or absent ovulation
2. Clinical or biochemical signs of excess androgens
3. Polycystic ovaries on ultrasound

Treatment

Lifestyle modifications:

• Weight management (even 5-10% weight loss can improve symptoms)
• Regular exercise
• Healthy diet

Medical treatments:

• Combined oral contraceptive pill (regulates periods, improves acne and hirsutism)
• Metformin (improves insulin sensitivity)
• Anti-androgen medications
• Fertility treatments (clomiphene, letrozole, gonadotrophins, IVF)

Menopause Management

What Is Menopause?

Menopause is when periods stop permanently, usually between ages 45-55. Perimenopause is the transition period leading up to menopause when symptoms often begin.

Common Symptoms

• Hot flushes and night sweats
• Sleep disturbance
• Mood changes (anxiety, low mood, irritability)
• Vaginal dryness and discomfort
• Reduced libido
• Joint aches
• Brain fog and memory problems
• Urinary symptoms

Treatment Options

Hormone Replacement Therapy (HRT):

• Most effective treatment for menopausal symptoms
• Available as tablets, patches, gels, or sprays
• Localised oestrogen for vaginal symptoms
• Benefits and risks discussed individually

Non-hormonal options:

• Vaginal moisturisers and lubricants
• Certain antidepressants (for hot flushes)
• Cognitive behavioural therapy (CBT)
• Lifestyle modifications

We provide personalised menopause consultations to discuss your symptoms and treatment options.

Contraception

We offer advice and provision of all contraceptive methods:

• Combined oral contraceptive pill
• Progestogen-only pill
• Contraceptive patch and ring
• Contraceptive injection
• Contraceptive implant
• Intrauterine device (IUD/copper coil)
• Intrauterine system (IUS/Mirena)
• Emergency contraception

We can help you choose the best method based on your health, lifestyle, and preferences.

Book a Consultation

If you’re experiencing any gynaecological symptoms or need routine screening, our team is here to help. Contact us at info@salamivf.com or call +973 1725 5095 to schedule an appointment.

12 - Contraception Services

Our Contraception Services provide comprehensive advice, fitting, and ongoing support for all methods of contraception. We help you choose the method that best suits your health, lifestyle, and family planning goals, ensuring you have the information you need to make an informed decision.

Why Contraception Matters

Effective contraception allows you to:

• Plan if and when to have children
• Space pregnancies for optimal health
• Manage certain medical conditions
• Take control of your reproductive health

Overview of Contraceptive Methods

Effectiveness rates depend on correct and consistent use

Hormonal Contraception

Combined Oral Contraceptive Pill

The combined pill contains oestrogen and progestogen hormones.

How it works:

• Prevents ovulation
• Thickens cervical mucus
• Thins the uterine lining

How to take it:

• One pill daily for 21 days, then 7-day break (or continuous use)
• Must be taken at roughly the same time each day

Benefits:

• Highly effective when taken correctly
• Regulates periods and reduces period pain
• Can improve acne and reduce PMS symptoms
• May reduce risk of ovarian and endometrial cancer
• Periods can be skipped if desired

Considerations:

• Not suitable for women over 35 who smoke
• Not suitable for women with certain health conditions (migraine with aura, blood clots, certain heart conditions)
• Does not protect against STIs
• Requires daily compliance

Side effects:

• Nausea, headaches, breast tenderness (usually temporary)
• Mood changes
• Breakthrough bleeding (especially in first few months)

Progestogen-Only Pill (Mini Pill)

The progestogen-only pill contains only progestogen hormone.

How it works:

• Thickens cervical mucus
• May prevent ovulation (depending on type)
• Thins the uterine lining

Types:

• Traditional POP — Must be taken within 3-hour window daily
• Desogestrel POP — 12-hour window, more likely to stop ovulation

Benefits:

• Suitable for women who cannot take oestrogen
• Safe while breastfeeding
• Suitable for women over 35 who smoke
• Can be used by women with migraine with aura

Considerations:

• Must be taken at the same time every day
• Periods may become irregular or stop
• Does not protect against STIs

Contraceptive Patch

The patch releases oestrogen and progestogen through the skin.

How to use it:

• Apply one patch weekly for 3 weeks
• Patch-free week (or continuous use)
• Apply to buttocks, abdomen, upper arm, or back

Benefits:

• Only needs changing once a week
• Same benefits as combined pill
• Still works if you have vomiting or diarrhoea

Considerations:

• Visible on skin
• May cause skin irritation
• Same contraindications as combined pill

Vaginal Ring

The ring releases oestrogen and progestogen inside the vagina.

How to use it:

• Insert ring and leave for 3 weeks
• Remove for 1 week (or use continuously)
• You insert and remove it yourself

Benefits:

• Only needs attention once a month
• Same benefits as combined pill
• Discreet

Considerations:

• Some women feel uncomfortable inserting/removing
• May be felt during intercourse (usually not problematic)
• Same contraindications as combined pill

Contraceptive Injection

The injection contains progestogen and is given every 8-13 weeks.

Types:

• Depo-Provera — Given every 12-13 weeks
• Sayana Press — Can be self-injected every 13 weeks
• Noristerat — Given every 8 weeks

Benefits:

• No daily or weekly action required
• Very effective
• Periods often become lighter or stop
• Not affected by other medications

Considerations:

• Periods may become irregular
• Fertility may take time to return after stopping (up to 1 year)
• Cannot be reversed once given
• May cause weight gain
• Long-term use may affect bone density

Contraceptive Implant

The implant is a small flexible rod inserted under the skin of the upper arm.

How it works:

• Releases progestogen slowly over 3 years
• Prevents ovulation
• Thickens cervical mucus

Fitting:

• Quick procedure under local anaesthetic
• Small incision in upper arm
• Takes effect immediately if fitted at right time in cycle

Benefits:

• Highly effective (>99%)
• Lasts up to 3 years
• Fertility returns immediately after removal
• Suitable for women who cannot use oestrogen
• Safe while breastfeeding

Considerations:

• Requires minor procedure for fitting and removal
• Periods may become irregular, lighter, heavier, or stop
• Small risk of infection at insertion site

Intrauterine Contraception

Hormonal IUS (Mirena, Kyleena, Jaydess)

The intrauterine system is a small T-shaped device placed in the uterus that releases progestogen.

Types:

• Mirena — Lasts up to 5 years, also treats heavy periods
• Kyleena — Lasts up to 5 years, smaller size
• Jaydess — Lasts up to 3 years, smallest size

How it works:

• Releases progestogen locally in the uterus
• Thickens cervical mucus
• Thins uterine lining
• May prevent ovulation

Fitting:

• Inserted through the cervix into the uterus
• Takes a few minutes
• May cause cramping during and after insertion

Benefits:

• Highly effective (>99%)
• Long-lasting (3-5 years)
• Reduces heavy periods significantly (Mirena)
• Low-dose hormone with minimal systemic effects
• Fertility returns immediately after removal

Considerations:

• Insertion may be uncomfortable
• Risk of expulsion (especially in first few months)
• Periods may become irregular initially
• Small risk of infection after insertion
• Rare risk of perforation during insertion

Copper IUD (Coil)

The copper IUD is a non-hormonal intrauterine device.

How it works:

• Copper is toxic to sperm
• Prevents fertilisation
• May prevent implantation

Fitting:

• Same procedure as IUS
• Takes effect immediately
• Can be used as emergency contraception

Benefits:

• Hormone-free
• Lasts up to 10 years (depending on type)
• Fertility returns immediately after removal
• Can be used as emergency contraception (within 5 days)

Considerations:

• Periods may become heavier, longer, or more painful
• Insertion may be uncomfortable
• Same risks as IUS (expulsion, infection, perforation)
• Not suitable for women with heavy periods

Barrier Methods

Male Condoms

Benefits:

• Protects against STIs and pregnancy
• No hormones
• Widely available
• No prescription needed

Effectiveness:

• 82% typical use, 98% perfect use

Considerations:

• Must be used correctly every time
• Can break or slip off
• Some people have latex allergies (non-latex options available)

Female Condoms

Benefits:

• Woman-controlled STI and pregnancy protection
• Can be inserted before intercourse
• No hormones

Effectiveness:

• 79% typical use, 95% perfect use

Diaphragm/Cap

How it works:

• Barrier placed over the cervix before intercourse
• Used with spermicide

Considerations:

• Must be fitted initially
• Must be left in place for 6 hours after intercourse
• Less effective than other methods

Emergency Contraception

Emergency contraception can prevent pregnancy after unprotected intercourse or contraceptive failure.

Emergency Contraceptive Pills

Levonorgestrel (Levonelle):

• Most effective within 72 hours (3 days)
• Can be used up to 96 hours
• Available without prescription

Ulipristal acetate (ellaOne):

• Effective up to 120 hours (5 days)
• More effective than levonorgestrel
• Requires prescription

Copper IUD

• Most effective form of emergency contraception
• Can be inserted up to 5 days after unprotected intercourse
• Can then be left in as ongoing contraception
• Over 99% effective

Permanent Contraception

Female Sterilisation

What it involves:

• Surgical procedure to block or remove fallopian tubes
• Usually performed laparoscopically
• Permanent — should be considered irreversible

Effectiveness: >99%

Considerations:

• Requires surgery and anaesthesia
• Cannot be easily reversed
• Does not affect hormones or periods
• Suitable for women certain they don’t want future pregnancies

Male Sterilisation (Vasectomy)

What it involves:

• Surgical procedure to cut or block the vas deferens
• Performed under local anaesthesia
• Takes about 3 months to be effective (sperm count test required)

Effectiveness: >99%

Considerations:

• Simpler procedure than female sterilisation
• Cannot be easily reversed
• Does not affect hormones or libido

Choosing the Right Method

When helping you choose contraception, we consider:

Your Health

• Medical conditions
• Medications you take
• Family history
• Risk factors (smoking, weight, blood pressure)

Your Lifestyle

• Whether you can remember daily pills
• How important it is to have regular periods
• Your relationship status
• Frequency of intercourse

Your Plans

• Whether you want children in the future
• How soon you might want to conceive
• Short-term vs long-term contraception needs

Your Preferences

• Hormonal vs non-hormonal
• Reversible vs permanent
• Method of use (pill, injection, device)
• STI protection needs

What to Expect at Your Appointment

Contraception Consultation

1. Discussion — Your medical history, lifestyle, and preferences
2. Information — Explanation of suitable options
3. Decision — Choosing the method that’s right for you
4. Provision — Prescription, fitting, or referral as needed
5. Follow-up — Scheduled check-up to ensure method is working well

IUD/IUS Fitting

1. Pre-appointment — Discussion of procedure and consent
2. Examination — Pelvic examination to assess uterus position
3. Insertion — Device inserted through cervix (may cause cramping)
4. Aftercare — Rest briefly, instructions for home
5. Follow-up — Check-up after 6 weeks

Implant Fitting

1. Consultation — Confirm suitability and consent
2. Local anaesthetic — Arm is numbed
3. Insertion — Small incision, implant placed under skin
4. Aftercare — Dressing applied, instructions provided
5. Follow-up — As needed

Frequently Asked Questions

Will contraception affect my fertility? Most contraceptive methods do not affect long-term fertility. Fertility returns quickly after stopping most methods. The injection may delay return of fertility by up to 1 year.

Can I use contraception while breastfeeding? Yes. Progestogen-only methods (mini pill, implant, injection, IUS) are safe while breastfeeding. The combined pill is usually avoided in the first 6 weeks postpartum.

Which method is best for heavy periods? The hormonal IUS (Mirena) is excellent for heavy periods. The combined pill and injection can also help reduce bleeding.

Do I need to take breaks from hormonal contraception? No. There is no medical need to take breaks from hormonal contraception. You can use most methods continuously until you want to conceive or reach menopause.

At what age should I stop contraception? Contraception is recommended until you’ve had no periods for 2 years if under 50, or 1 year if over 50. We can advise on appropriate timing.

Book a Consultation

If you’d like to discuss your contraception options or need a fitting or review, our team is here to help. Contact us at info@salamivf.com or call +973 1725 5095 to schedule an appointment.

13 - Laparoscopic Surgery

Our Laparoscopic Surgery Services offer minimally invasive surgical solutions for a wide range of gynaecological conditions. Using advanced keyhole techniques, we can diagnose and treat conditions with smaller incisions, less pain, and faster recovery compared to traditional open surgery.

What Is Laparoscopic Surgery?

Laparoscopic surgery (also called keyhole surgery or minimally invasive surgery) is a surgical technique where operations are performed through small incisions (usually 0.5-1.5 cm) using a camera and specialised instruments.

How It Works

1. Small incisions are made in the abdomen (usually 2-4)
2. Carbon dioxide gas is used to inflate the abdomen, creating space to operate
3. A laparoscope (thin camera) is inserted to visualise the pelvic organs
4. Specialised instruments are used to perform the surgery
5. The incisions are closed with dissolvable stitches or surgical glue

Benefits of Laparoscopic Surgery

Our Laparoscopic Procedures

Diagnostic Laparoscopy

What is it? Diagnostic laparoscopy is a procedure to examine the pelvic organs directly when other tests haven’t provided a clear diagnosis.

When is it recommended?

• Investigation of chronic pelvic pain
• Suspected endometriosis
• Unexplained infertility
• Assessment of pelvic masses
• Evaluation of congenital abnormalities

What happens during the procedure?

• A small incision is made near the umbilicus (belly button)
• The laparoscope is inserted to examine the uterus, ovaries, fallopian tubes, and surrounding structures
• Photographs or video may be taken for documentation
• Biopsies can be taken if needed
• Treatment can often be performed at the same time

Recovery:

• Usually a day-case procedure
• Mild discomfort and bloating for a few days
• Return to normal activities within 1-2 weeks

Ectopic Pregnancy Surgery

What is an ectopic pregnancy? An ectopic pregnancy occurs when a fertilised egg implants outside the uterus, most commonly in the fallopian tube. This is a potentially life-threatening condition that requires urgent treatment.

Symptoms of ectopic pregnancy:

• Missed period with positive pregnancy test
• One-sided abdominal or pelvic pain
• Vaginal bleeding or spotting
• Shoulder tip pain
• Dizziness, fainting, or collapse (emergency signs)

Surgical options:

Salpingectomy (tube removal):

• Removal of the affected fallopian tube
• Recommended when the tube is severely damaged
• Does not significantly reduce future fertility (remaining tube compensates)
• May be preferred if you have completed your family

Salpingotomy (tube-sparing surgery):

• The ectopic pregnancy is removed while preserving the tube
• Considered when preserving fertility is important
• Small risk of persistent ectopic tissue (requires follow-up)
• May be preferred if you have only one tube or previous tubal damage

Emergency surgery:

• If the ectopic has ruptured, emergency surgery is required
• May need to be performed as open surgery if there is significant bleeding
• Blood transfusion may be necessary

Recovery:

• Hospital stay: 1-3 days depending on complexity
• Physical recovery: 2-4 weeks
• Emotional support available throughout

Ovarian Cyst Surgery

When is surgery needed? Not all ovarian cysts require surgery. Surgery may be recommended for:

• Large cysts (usually >5-6 cm)
• Cysts causing symptoms (pain, pressure)
• Cysts with concerning features on ultrasound
• Cysts that don’t resolve on their own
• Suspected endometriomas
• Dermoid cysts (teratomas)

Types of surgery:

Ovarian cystectomy:

• Removal of the cyst while preserving the ovary
• Preferred approach, especially for women wanting future fertility
• The ovary heals and continues to function normally

Oophorectomy:

• Removal of the entire ovary
• May be necessary for very large cysts, torsion, or concerning features
• The remaining ovary compensates for hormone production

What to expect:

• Usually 2-3 small incisions
• Day-case or overnight stay
• Cyst sent for laboratory analysis
• Results discussed at follow-up appointment

Recovery:

• Return to light activities: 1 week
• Return to normal activities: 2-3 weeks
• Avoid heavy lifting for 4-6 weeks

Adhesiolysis (Adhesion Removal)

What are adhesions? Adhesions are bands of scar tissue that form between organs and tissues in the abdomen and pelvis. They can cause organs to stick together, leading to pain and other complications.

Causes of adhesions:

• Previous surgery (most common cause)
• Endometriosis
• Pelvic infections
• Appendicitis
• Inflammatory conditions

Symptoms:

• Chronic pelvic pain
• Pain during intercourse
• Infertility (if fallopian tubes are affected)
• Bowel obstruction (in severe cases)

Laparoscopic adhesiolysis:

• Careful division of adhesion bands
• Restoration of normal anatomy
• Release of trapped organs
• Improved mobility of pelvic structures

Benefits:

• Reduced pain
• Improved fertility potential
• Better organ function
• Prevention of complications

Considerations:

• Adhesions can recur after surgery
• Barrier agents may be used to reduce recurrence
• Severity of adhesions affects surgical complexity

Laparoscopic Myomectomy

What is it? Laparoscopic myomectomy is the removal of uterine fibroids while preserving the uterus. This is an important option for women who wish to maintain fertility.

When is it suitable?

• Symptomatic fibroids causing heavy bleeding, pain, or pressure
• Fibroids affecting fertility
• Women who want to preserve their uterus
• Fibroids suitable for laparoscopic removal (size and location)

The procedure:

• Fibroids are identified and carefully removed from the uterine wall
• The uterine defect is repaired with sutures
• Specimens are removed through a small incision or morcellator

Recovery:

• Hospital stay: 1-2 days
• Return to work: 2-4 weeks
• Avoid pregnancy for 3-6 months (to allow uterus to heal)

Considerations:

• Multiple or very large fibroids may require open surgery
• Risk of fibroid recurrence
• Future pregnancies may require caesarean section (depending on surgical technique)

Laparoscopic Hysterectomy

What is it? Laparoscopic hysterectomy is the removal of the uterus using keyhole surgery. This offers significant advantages over traditional open abdominal hysterectomy.

Types of laparoscopic hysterectomy:

When is hysterectomy recommended?

• Heavy menstrual bleeding not responding to other treatments
• Uterine fibroids causing significant symptoms
• Adenomyosis
• Endometriosis (severe cases)
• Uterine prolapse
• Chronic pelvic pain
• Gynaecological cancers (may require additional procedures)

Benefits of laparoscopic approach:

• Smaller incisions (3-4 small cuts vs one large abdominal incision)
• Less post-operative pain
• Shorter hospital stay (1-2 days vs 3-5 days)
• Faster recovery (2-4 weeks vs 6-8 weeks)
• Lower risk of infection and complications
• Better cosmetic result

The procedure:

1. Small incisions made in the abdomen
2. Uterus detached from supporting structures
3. Blood vessels secured
4. Uterus removed through the vagina or via morcellation
5. Vaginal cuff closed with sutures

Recovery timeline:

• Hospital stay: 1-2 nights
• Light activities: 1-2 weeks
• Driving: 2-3 weeks (when comfortable)
• Return to work: 2-4 weeks (depending on job)
• Full recovery: 4-6 weeks
• Avoid heavy lifting and intercourse: 6 weeks

Surgery for Endometriosis

Laparoscopic treatment options:

Excision of endometriosis:

• Cutting out endometriosis deposits
• Gold standard treatment
• Preserves tissue for diagnosis
• More thorough removal

Ablation of endometriosis:

• Burning or destroying superficial deposits
• Suitable for minimal disease
• Quicker procedure

Treatment of endometriomas:

• Drainage and removal of ovarian chocolate cysts
• Careful technique to preserve ovarian tissue

Treatment of deep infiltrating endometriosis:

• Complex surgery for advanced disease
• May involve bladder, bowel, or ureter
• Multidisciplinary team approach when needed

Benefits:

• Pain relief
• Improved fertility
• Accurate diagnosis and staging
• Tissue for histological confirmation

Before Your Surgery

Pre-operative assessment

• Medical history review
• Blood tests
• Examination
• Discussion of procedure, risks, and alternatives
• Consent process
• Anaesthetic assessment if required

Preparation instructions

• Fasting before surgery (usually from midnight)
• Medications to continue or stop
• What to bring to hospital
• Arrange transport home
• Plan for recovery period

After Your Surgery

Immediately after

• Recovery room monitoring
• Pain relief provided
• Assessment before discharge
• Post-operative instructions given

At home

Normal experiences:

• Mild to moderate abdominal discomfort
• Shoulder tip pain (from gas used during surgery) — usually resolves in 24-48 hours
• Bloating
• Fatigue
• Small amount of vaginal bleeding

Warning signs — contact us if you experience:

• Fever (temperature >38°C)
• Severe or worsening pain
• Heavy vaginal bleeding
• Inability to pass urine
• Signs of wound infection (redness, swelling, discharge)
• Nausea and vomiting preventing eating/drinking

Recovery tips

• Take prescribed pain relief regularly
• Move around gently to prevent blood clots
• Avoid heavy lifting for 4-6 weeks
• Avoid intercourse until advised (usually 4-6 weeks for hysterectomy)
• Gradually increase activity levels
• Attend follow-up appointments

Risks and Complications

As with any surgery, laparoscopic procedures carry some risks:

General risks:

• Anaesthetic complications
• Bleeding
• Infection
• Blood clots (DVT/PE)
• Wound complications

Specific to laparoscopy:

• Conversion to open surgery (if laparoscopy not possible)
• Injury to surrounding organs (bowel, bladder, blood vessels)
• Subcutaneous emphysema (gas under skin)
• Port-site hernia

These risks are generally lower with laparoscopic surgery compared to open surgery. We will discuss specific risks relevant to your procedure during your consultation.

Frequently Asked Questions

How long will I be in hospital? Most laparoscopic procedures are day-case or require one overnight stay. Complex procedures like hysterectomy typically require 1-2 nights.

When can I return to work? This depends on the procedure and your job:

• Desk job: 1-2 weeks (minor procedures), 2-4 weeks (major procedures)
• Physical job: 4-6 weeks

Will I have scars? Laparoscopic surgery uses small incisions (0.5-1.5 cm) that heal well and are usually barely visible after a few months.

Can all gynaecological surgery be done laparoscopically? Many procedures can be done laparoscopically, but some conditions (very large fibroids, advanced cancer, severe adhesions) may require open surgery. We will advise on the best approach for your situation.

Is laparoscopic surgery safe? Yes. Laparoscopic surgery is a well-established technique with an excellent safety record. In many cases, it’s safer than open surgery due to smaller incisions and faster recovery.

Book a Consultation

If you’ve been advised to consider surgery or would like to discuss your treatment options, our team is here to help. Contact us at info@salamivf.com or call +973 1725 5095 to schedule a consultation.

14 - Hysteroscopy

Our Hysteroscopy Services provide minimally invasive diagnosis and treatment of conditions affecting the inside of the uterus. Using a thin camera inserted through the cervix, we can directly visualise and treat abnormalities without the need for abdominal incisions.

What Is Hysteroscopy?

Hysteroscopy is a procedure that allows your doctor to look inside your uterus using a hysteroscope — a thin, lighted telescope-like instrument. The hysteroscope is passed through the vagina and cervix into the uterus, providing a clear view of the uterine cavity on a monitor.

Types of Hysteroscopy

Benefits of Hysteroscopy

• No incisions — Performed through the natural opening of the cervix
• Direct visualisation — Clear view of the uterine cavity
• Accurate diagnosis — Can see abnormalities that scans may miss
• Same-time treatment — Many conditions can be treated during the same procedure
• Quick recovery — Most women return to normal activities within 1-2 days
• Outpatient procedure — Often performed as a day case

Diagnostic Hysteroscopy

What Is It?

Diagnostic hysteroscopy is performed to investigate symptoms or abnormal findings on ultrasound. It allows direct visualisation of the uterine cavity to identify the cause of problems.

When Is It Recommended?

Abnormal bleeding:

• Heavy menstrual bleeding
• Bleeding between periods
• Postmenopausal bleeding
• Irregular periods

Fertility investigations:

• Recurrent miscarriage
• Unexplained infertility
• Before IVF treatment
• Assessment of uterine cavity

Abnormal scan findings:

• Suspected polyps
• Suspected fibroids
• Thickened endometrium
• Uterine abnormalities

Other indications:

• Lost intrauterine device (IUD)
• Follow-up after treatment
• Investigation of abnormal cells on smear

The Procedure

Outpatient (office) hysteroscopy:

1. Preparation — You may be advised to take pain relief before the procedure
2. Positioning — You lie on an examination couch with legs supported
3. Speculum — Inserted to visualise the cervix
4. Hysteroscope insertion — The thin camera is gently passed through the cervix
5. Uterine distension — Fluid or gas is used to expand the uterus for better visualisation
6. Examination — The uterine cavity is carefully examined
7. Biopsy — Samples may be taken if needed
8. Completion — The hysteroscope is removed; procedure takes 5-15 minutes

What you may feel:

• Mild cramping similar to period pain
• Pressure sensation
• Brief discomfort as the hysteroscope passes through the cervix

After the procedure:

• You can usually go home immediately
• Mild cramping may continue for a few hours
• Light spotting for a few days is normal
• Results discussed immediately or at follow-up

Operative Hysteroscopy

What Is It?

Operative hysteroscopy uses the hysteroscope along with specialised instruments to treat conditions found within the uterus. It combines diagnosis and treatment in one procedure.

Conditions Treated

Endometrial polyps:

• Benign growths from the uterine lining
• Common cause of abnormal bleeding
• Can affect fertility
• Removed using hysteroscopic polypectomy

Submucosal fibroids:

• Fibroids that protrude into the uterine cavity
• Cause heavy bleeding and fertility problems
• Removed using hysteroscopic myomectomy
• Preserves the uterus

Uterine adhesions (Asherman’s syndrome):

• Scar tissue inside the uterus
• Can cause absent or light periods
• May cause infertility or recurrent miscarriage
• Divided using hysteroscopic adhesiolysis

Uterine septum:

• A wall of tissue dividing the uterus
• Congenital abnormality
• Associated with miscarriage and preterm birth
• Corrected using hysteroscopic septoplasty

Endometrial ablation:

• Destruction of the uterine lining
• Treatment for heavy menstrual bleeding
• Alternative to hysterectomy
• Not suitable if future pregnancy desired

Retained products of conception:

• Tissue remaining after miscarriage or delivery
• Causes bleeding and infection risk
• Removed under direct vision

Lost IUD removal:

• When IUD strings are not visible
• Safe removal under direct visualisation

Procedures Explained

Hysteroscopic Polypectomy

What is it? Removal of endometrial polyps using instruments passed through the hysteroscope.

Techniques:

• Mechanical removal (grasping forceps, scissors)
• Electrosurgical resection
• Morcellation (for larger polyps)

Benefits:

• Relieves abnormal bleeding
• Improves fertility outcomes
• Provides tissue for analysis
• Preserves the uterus

Recovery:

• Usually day-case procedure
• Light bleeding for a few days
• Return to normal activities: 1-2 days

Hysteroscopic Myomectomy

What is it? Removal of submucosal fibroids (fibroids protruding into the uterine cavity) using the hysteroscope.

Suitable for:

• Type 0 fibroids (entirely within the cavity)
• Type 1 fibroids (>50% within the cavity)
• Type 2 fibroids (<50% within the cavity) — may require staged procedure

Techniques:

• Resectoscope with electrosurgical loop
• Hysteroscopic morcellation
• May require more than one procedure for large fibroids

Benefits:

• No abdominal incisions
• Preserves the uterus
• Improves heavy bleeding
• Improves fertility outcomes
• Shorter recovery than abdominal surgery

Recovery:

• Hospital stay: Day-case or overnight
• Return to work: 2-5 days
• Avoid intercourse: 2 weeks
• Full recovery: 1-2 weeks

Hysteroscopic Adhesiolysis

What is it? Division of intrauterine adhesions (scar tissue) to restore the normal uterine cavity.

Causes of adhesions:

• Previous uterine surgery (D&C, myomectomy, caesarean)
• Infection
• Radiation therapy

Symptoms:

• Absent or very light periods
• Infertility
• Recurrent miscarriage
• Pelvic pain

Procedure:

• Adhesions are carefully divided using scissors or electrosurgery
• Cavity is restored to normal shape
• Oestrogen therapy may be given after to promote healing
• Balloon or IUD may be placed temporarily to prevent re-adhesion
• Follow-up hysteroscopy may be needed

Success rates:

• Menstruation restored in most cases
• Pregnancy rates improve significantly
• Severe adhesions may require multiple procedures

Hysteroscopic Septoplasty

What is it? Removal of a uterine septum — a congenital wall of tissue that divides the uterine cavity.

Why treat it?

• Septum is associated with:
  • Recurrent miscarriage (up to 60% risk)
  • Preterm birth
  • Abnormal fetal presentation
  • Infertility

Procedure:

• Septum is divided using scissors or electrosurgery
• Procedure is guided by ultrasound or laparoscopy
• Creates a single unified uterine cavity

Outcomes:

• Miscarriage rate significantly reduced
• Improved pregnancy outcomes
• Better fetal positioning

Recovery:

• Day-case procedure
• Light bleeding for a few days
• Can try to conceive after 1-2 months

Endometrial Ablation

What is it? Destruction of the uterine lining (endometrium) to reduce or stop menstrual bleeding.

Who is it suitable for?

• Women with heavy menstrual bleeding
• Women who have completed their family
• Women who want to avoid hysterectomy
• Not suitable if future pregnancy is desired

Techniques:

• Thermal balloon ablation
• Radiofrequency ablation (NovaSure)
• Microwave ablation
• Resectoscopic ablation

Expected outcomes:

• 90% of women have reduced bleeding
• 40-50% have no periods after treatment
• Some women may still need hysterectomy later

Important considerations:

• Contraception still required (pregnancy dangerous after ablation)
• Permanent procedure — cannot be reversed
• May make future investigation of uterus difficult

Recovery:

• Day-case procedure
• Cramping and watery discharge for 2-4 weeks
• Return to normal activities: 1-3 days

Before Your Hysteroscopy

Preparation

Timing:

• Diagnostic: Best performed in first half of cycle (after period, before ovulation)
• Operative: May be scheduled based on procedure type

Pre-procedure instructions:

• Eat normally (unless general anaesthetic planned)
• Take recommended pain relief 1 hour before
• Bring someone to accompany you home (if sedation used)
• Empty bladder before procedure

What to bring:

• Sanitary pads (not tampons)
• Comfortable clothing
• List of medications
• Insurance/ID documents

Anaesthesia Options

After Your Hysteroscopy

Immediately After

• Rest in recovery area until ready to leave
• Light refreshments offered
• Post-procedure instructions provided
• Results discussed (or at follow-up)

At Home

Normal experiences:

• Mild cramping (like period pain) for 1-2 days
• Light vaginal bleeding or spotting for up to 2 weeks
• Watery or blood-tinged discharge
• Feeling tired

What to avoid:

• Tampons — use pads only for 2 weeks
• Sexual intercourse — wait 1-2 weeks (or as advised)
• Swimming/baths — showers only for 1 week
• Heavy lifting — for 1-2 weeks after operative procedures

When to contact us:

• Heavy bleeding (soaking more than 1 pad per hour)
• Fever (temperature >38°C)
• Severe abdominal pain not relieved by painkillers
• Foul-smelling discharge
• Unable to pass urine

Recovery Timeline

Risks and Complications

Hysteroscopy is generally very safe, but like any procedure, carries some risks:

Common (temporary):

• Cramping
• Light bleeding
• Feeling faint during procedure

Uncommon:

• Infection (treated with antibiotics)
• Failure to complete procedure
• Need for repeat procedure

Rare:

• Uterine perforation (small hole in uterus) — usually heals on its own
• Heavy bleeding requiring treatment
• Damage to cervix
• Fluid overload (with operative procedures)

Risk factors for complications:

• Previous cervical surgery
• Postmenopausal status (narrower cervix)
• Large fibroids or complex anatomy
• Longer operative procedures

Overall complication rate is less than 1% for diagnostic hysteroscopy and around 2% for operative procedures.

Hysteroscopy and Fertility

Hysteroscopy plays an important role in fertility treatment:

Before IVF

• Identifies and treats polyps, fibroids, adhesions
• Corrects uterine abnormalities
• May improve implantation rates
• Often recommended after failed IVF cycles

Recurrent Miscarriage

• Diagnoses uterine abnormalities
• Treats septum, adhesions, polyps
• Improves chances of successful pregnancy

Unexplained Infertility

• Evaluates uterine cavity when other tests normal
• May find subtle abnormalities missed on ultrasound
• “Scratch” procedure may improve implantation (endometrial scratching)

Frequently Asked Questions

Is hysteroscopy painful? Most women experience mild discomfort similar to period cramps. Outpatient procedures are well-tolerated with simple pain relief. More complex procedures are done under sedation or general anaesthesia.

How long does hysteroscopy take? Diagnostic hysteroscopy takes 5-15 minutes. Operative procedures take 15-60 minutes depending on complexity.

Can I drive home after hysteroscopy? If you have no anaesthesia or only local anaesthesia, you can usually drive. If you have sedation or general anaesthesia, you will need someone to take you home.

When can I try to conceive after hysteroscopy? For diagnostic procedures, you can try immediately. After operative procedures, we usually recommend waiting 1-2 months to allow healing.

Will hysteroscopy affect my fertility? Hysteroscopy is designed to improve fertility by treating conditions that may be preventing pregnancy. When performed correctly, it does not damage fertility.

Is hysteroscopy better than D&C? Yes, in most cases. Hysteroscopy allows direct visualisation and targeted treatment, whereas D&C is a blind procedure. Hysteroscopy has lower complication rates and better outcomes.

Book a Consultation

If you’ve been advised to have a hysteroscopy or would like to discuss whether it might help your symptoms, our team is here to help. Contact us at info@salamivf.com or call +973 1725 5095 to schedule an appointment.