Reproductive medicine spans the reproductive years and therefore includes the management of adolescents as well as women approaching the menopause. We focus on patients between these extremes and particularly couples with subfertility and those who have experienced complications in early pregnancy.
We approach these issues in a variety of ways but a significant part of our work involves imaging and specifically ultrasound. We use a variety of ultrasound techniques (2D, 3D, Doppler, and contrast) which we combine with biomarkers to assess disease processes both qualitatively and quantitatively. We also use these techniques to explore physiology and address ‘uncertainties’ in reproductive medicine.
What we are doing about...
We are conducting a range of studies to better understand the causes of subfertility and to improve the chance of livebirth and reduce the risk of miscarriage.
Much of our work focuses on assisted conception and IVF treatment.
We have developed several different prediction models for women undergoing IVF based on their ovarian reserve and endometrial receptivity which allow us to issue individualised treatment protocols. IVF is all about ‘marginal gains’ and we continue to look into all aspects of care before, during and after treatment to give women and their partners the very best chance of success.
Our work extends to the emotional well-being of women, and their partners, which we believe not only impacts on treatment experience but also influences outcome. Furthermore, we believe this is treatable.
2. Problems in Early Pregnancy
We have conducted several studies which explore the uncertainties in early pregnancy including pregnancies of unknown location and uncertain viability.
We revisited the historical data that exist on the development of normal early pregnancies and then applied this to complicated pregnancies.
We have also explored the effect of subfertility, assisted conception and multiple pregnancy on early development and long term outcome.
We set up and led the James Lind Priority Setting Partnership which established the Top 10 uncertainties in miscarriage. Our findings were published in the BMJ Open and will help funders rationalise research priorities with input from all stakeholders including our patients.
Finally, we continue to conduct studies looking at the effect of pelvic pathology and its’ treatment on both conception and pregnancy outcome. A key area in this respect is the role of congenital uterine anomalies and hysteroscopic resection of uterine septae.
Endometrial receptivity and implantation failure
We are conducting a series of studies looking at the role of the endometrium in the implantation process. We are re-exploring the role of ‘pattern recognition’ and endometrial development to see if we can develop a quick and easy assessment that predicts ‘non-pregnancy’ and therefore the need to freeze embryos for transfer at a later date. The ultrasound information will be correlated with endometrial genomics, histology and endocrine profiles.
We are also investigating the role of natural killer (NK) cells and other markers of decidualisation with the Reproductive Health team at the University of Warwick (Professors Jan Brosens and Siobhan Quenby).
Video: The Endoscratch study
The Endoscratch Study is a randomised controlled trial looking at the effect of endometrial biopsy in women undergoing assisted conception treatment.
Uncertainties in early pregnancy
Miscarriage and ectopic pregnancy are increasingly common and largely unpreventable. Despite this there are many uncertainties in early pregnancy both in respect of when things go wrong and in the normal developmental processes.
We are conducting a series of studies to see where treatment strategies could be targetted. Some of these uncertainties are being highlighted in a series of systematic reviews we are conducting in conjunction with the School of Clinical and Experimental Medicine in Birmingham (Professor Arri Coomarasamy).
Our latest project takes us back to work we conducted in the noughties (2002-2008) which looked at ultrasound determinants of ovarian reserve.
This time we are focusing on simple ultrasound parameters, including pattern recognition, to predict ovarian response and then individualise this for each woman.
We also aim to redefine the polycystic ovary and demystify this enigmatic disease and its’ diagnosis.
We have just completed a 3-year study into embryo transfer.
We have developed a new grading system of ‘difficulty’ which we have used to predict outcome. Our aim is to predict difficulty and modify the approach accordingly allowing the seamless transfer of embryos in a timely manner.
Publications in leading peer-reviewed journals. Please see the publication records under our members' profiles.
1. Craciunas, L., Tsampras, N., Coomarasamy, A., Raine-Fenning, N., 2016. Intrauterine administration of human chorionic gonadotropin (hCG) for subfertile women undergoing assisted reproduction. Cochrane Database Syst Rev, CD011537.
2. Culley, L., Law, C., Hudson, N., Mitchell, H., Denny, E., Raine-Fenning, N., 2017. A qualitative study of the impact of endometriosis on male partners. Hum Reprod, 1-7.
3. Durairaj, R.R.P., Aberkane, A., Polanski, L., Maruyama, Y., Baumgarten, M., Lucas, E.S., Quenby, S., Chan, J.K.Y., Raine-Fenning, N., Brosens, J.J., Van de Velde, H., Lee, Y.H., 2017. Deregulation of the endometrial stromal cell secretome precedes embryo implantation failure. Molecular Human Reproduction 23, 478-487.
4. Prior, M., Bagness, C., Brewin, J., Coomarasamy, A., Easthope, L., Hepworth-Jones, B., Hinshaw, K., O'Toole, E., Orford, J., Regan, L., Raine-Fenning, N., Shakespeare, J., Small, R., Thornton, J., Metcalf, L., 2017. Priorities for research in miscarriage: a priority setting partnership between people affected by miscarriage and professionals following the James Lind Alliance methodology. BMJ Open 7
University spin-out: Nurture Fertility
Nurture Fertility provides a high quality clinical service in assisted reproduction techniques and a teaching and research base in this area.
More about Nurture
Nurture have achieved and maintained some of the highest success rates seen in the UK over the last 5-10 years and continue to deliver cutting edge research and training as well as an excellent bespoke clinical service for patients in the Midlands.
Nurture Fertility was set up in 1991 and successfully span out by the University in 2014. The number of cycles have almost trebled in the last three years and continue to grow whilst success rates and high quality service have not only been maintained but improved year on year.
Nurture Fertility is led by Dr Nick Raine-Fenning and his University of Nottingham colleague James Hopkisson. Nick and James teach on the University’s Masters Course in Assisted Reproduction and welcome undergraduate and postgraduate students to Nurture on a regular basis.