One Stop Clinic

It is a new approach to the diagnosis of infertility organised at SISMeR’s Bologna Centre, that receives couples by putting at their immediate disposal:

• a team of Reproductive Medicine specialists (gynaecologists, andrologists, geneticists and psychologists);
• the possibility of undergoing, on the same day, all the first and second-level tests that, on the basis of clinical evidence, are able to provide the information required for formulating an initial diagnosis and devising the subsequent reproductive programme together with the couple.

For couples who, after 12-18 months of unsuccessful attempts at conceiving, are interested in finding out, very quickly, what, if any, obstacle exists to their reproductive capacity and what the recommended next step is.

Finding out that they are unable to reproduce has a profound psychological effect on couples, that can have repercussions on daily family and emotional life.
By seeking medical advice, they discover that the problem cannot be tackled immediately and that they have to follow a diagnostic and therapeutic pathway, often consisting in several steps, that can take a long time and does not guarantee success.
The diagnostic work-up involves an initial series of relatively straight-forward tests that are clearly outlined in evidence-based medicine Guidelines. All too often, however, these tests take time (recommendation, prescription, performance) and are performed in different healthcare facilities, making them time and energy-consuming.
In addition to this, at the end of the diagnostic pathway, it is not always possible to formulate a “certain diagnosis” and the consequent uncertainty can further increase the level of stress.
Even when they are unable to identify the cause of infertility, diagnostic tests are nevertheless of paramount importance for developing the subsequent programme. However, anxiety and uncertainty often make the couple psychologically weaker in precisely the moment when they need to recover physical and psychological energy, in order to face the treatment programme that follows.
The therapeutic pathway is, in turn, influenced by the knowledge that even the most sophisticated treatments never guarantee success and that the desire to become parents may not be satisfied. Repeated failures can lead couples to a state of deep depression.

How can we help couples to get through this experience in a more positive way, guiding them through a process of maturation, rather than regression?
No more than 10-15 years ago, infertile couples had very few options. Today, medical progress has opened up possibilities that give infertile couples the chance to choose. In order to help couples face this pathway, they need to be actively involved in every step of the process. From the outset, couples must be given all the information they need to fully understand their “reproductive programme”, in order to allow them to make well-informed choices and so that they always know “where they are”, “where they can go” and “just how far they can go”.

In this scenario, the One Stop Clinic aims to provide those couples requesting it with a procedure that from the very first encounter involves performing the tests the partners may require. With just “one stop”, couples can receive the information they need to decide whether to continue and which road to take.
Cutting and rationalising time as far as possible can help the couple to come to terms with their infertility with less anxiety.

Interested couples need to call SISMeR to book an appointment.
On the allotted day, the couple must report to the Centre at 8:30 in the morning to receive details of the day’s programme, which might require them to stay at the centre until as late as 6.00 p.m.
During the day, the couple will have appointments with various specialists and will have the diagnostic tests considered necessary according to their individual characteristics.

Tests that can be performed during the One Stop Clinic address:

– the male partner:

• Specialist andrology appointment
• Semen analysis

and, only if necessary:

• Sperm DNA testing
• Birefringence test
• Preparation of a semen sample for chromosome analysis
• Blood sample for hormone tests (LH, FSH, Testosterone, Prolactin) and genetic tests (karyotype, cystic fibrosis, Y chromosome microdeletion)

– the female partner:

• Gynaecological examination and gynaecological ultrasound scan
• Diagnostic hysteroscopy

and, only if necessary:

• Hysterosonosalpyngography
• Cervical smear and colposcopy
• Blood sample for hormonal tests (FSH, LH, Oestradiol, Prolactin, TSH, Androgens, Progesterone), genetic tests (karyotype, cystic fibrosis, fragile X syndrome) and thrombophilia screening.

At the end of the day, with the results of the tests performed, the couple will have a talk with the specialist to take stock of the situation. More specifically:

To explain the results obtained;
To plan the subsequent steps of the programme, which differ from one couple to the next and must be scheduled according to the test results and the individual couple’s characteristics.
The various options may include:
– waiting a little longer without further tests or treatments, when there is a realistic possibility of spontaneous conception. Couples should consider this option a “therapeutic choice” rather than a “waste of time”. However, the length of the wait should be specified (6-12 months) and the couple must be told, at this point, about the subsequent steps to be taken if the infertility persists. Having a clear idea of “what to do afterwards” is of fundamental importance to facing the waiting period with less anxiety;
– performing any further investigations considered necessary for completing or confirming the diagnosis. In this case, the couple are provided with information on the tests prescribed: where, how and why they are to be performed;
– prescription of medical therapy for the man or woman. The couple must be re-assessed in the following months (after 3-6 months) to monitor the outcome of the treatment prescribed and to plan the subsequent options. Although this occurrence is rare, it may transpire during the first meeting that surgical treatment (laparoscopy or operative hysteroscopy, surgical sperm collection, etc.) is required for therapeutic purposes;
– recommendation to proceed with 1^st, 2^nd or 3^rd level Medically-Assisted Procreation (MAP) treatments. In this case, couples are provided with information on the treatments, in order to put them in a position to weigh up the situation and make well-informed decisions on the option that they believe best suits their requirements;
– recommending no further treatment because even the most sophisticated techniques would not offer realistic chances of success.

When they are discharged, the couple will be given a written report with the test results, any prescriptions and suggestions for their future programme. A copy of the report will be sent to the female partner’s usual gynaecologist.

The One Stop Clinic is therefore a “short but intense relationship” between the couple and the SISMeR facility. In any case, by the end of it, the couple will know what action to take in a field that all too frequently creates great confusion.
If the couple wishes, they may contact SISMeR again at any time for further investigations or medical, surgical or any kind of MAP treatments.

By contacting the SISMeR Centre in Bologna

The cost includes all the clinical and instrumental tests and procedures and specialist consultations the couple has during the day. Full information on costs is available from the SISMeR administration department.
The cost does not include fees for the genetic tests (karyotype, cystic fibrosis, Y chromosome microdeletion, genetic thrombophilia screening) and hormone tests the couple may decide to have at our Centre, the results of which will arrive at a later date because it is not possible to obtain results the same day.